Worth Switches from an Outdated Infirmary Model to a Primary Care Model

In an email on August 11, 2014, Beth Kotarski, the Director of Student Health and Wellness Services, informed students that Worth Health Center was changing the way students could access care from 8pm to 8am on weekdays and 4pm to 10am on weekends, in a switch from an “infirmary model” to a “primary care model.” Instead of going to Worth during these hours, students can now call a nurse on call, also known as an emergency triage member.

The reasoning behind the change was to make Swarthmore’s health care services safer and more in line with what other peer institutions have been doing to ensure quality care for students. The infirmary model, in which a nurse stays overnight at the health center, has long been considered outdated by college health care professionals.

A comparison with peer institutions (schools in the Council of Private Higher Education, or COPHE schools) conducted by Swarthmore’s Student Health Advisory Council found that Swarthmore was the last college to switch over from an infirmary model. In fact, the last college to switch within Swarthmore’s peer group did so more than 20 years ago. A New York Times article as far back as 2005 covered the death of the infirmary model.

In an interview with The Daily Gazette, Beth Kotarski said, “If this [the infirmary model] were a safer model, even if it was safer for one student, I would say ‘We’re going to keep this’ but it is so risky for our larger student population. That’s why we’ve gotten rid of it.”

The infirmary model was dangerous because with only one nurse in the health center, that registered nurse (RN) was not equipped to handle situations where more than one student would come in at a time. If a student were to come in while the RN was caring for another student, they might have to wait to receive care, a potentially unsafe situation if the student needed immediate or emergency care.

Due to busy class schedules, students would also come to Worth late at night to get small problems like sore throats checked that could easily wait until morning. Kotarski wants to end this habit and encourage students to prioritize their health more: “If you’re sick you need to come in and take care of yourself because you’re a human first and a student second.”

Kotarski mentioned when she first came to Swarthmore seven years ago, students would also use Worth as a “drunk tank,” or a place to stay when they were intoxicated. This was an unsafe practice and now, students who have reached dangerous levels of intoxication are always advised to call Public Safety and go to the hospital.

In the new model, students can receive medical triage from their rooms or anywhere on campus. This is a practice where the RN assesses whether the patient should go to the hospital, schedule an appointment in the morning, or implement a quick remedy like taking an ibuprofen and go back to bed. This is the system officially recommended by the American College Health Association.

There has not been any increase in hospital visits since the new model has been implemented, compared to this time last year. September is always a busy time for Worth, with higher numbers of athletic injuries and students returning to campus sick and in need of care. There has also been a steady decline in students requiring medical services due to intoxication, which Kotarski hopes is a testament to the school’s efforts at alcohol education and the work of Josh Ellow, the Alcohol and Other Drugs Counselor.

Kotarski said this change has improved Swarthmore’s services immensely by bringing it into the 21st century. Another way Worth is looking to improve is by having a larger focus on preventive care. They are conducting an active search for a Wellness Coordinator and are always trying to find ways to encourage to care about their health all the time, not just when they get sick.

“Today colleges are graduating a community of folks who might be stressed out and sicker than when they started college and that shouldn’t be the case. The goal of colleges, the goal of Swarthmore should be to graduate someone who is healthier than when we found them.” Kotarski said.

The Worth nurse on call after-hours can be reached at 610-328-8548.


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