By Nancy Pieraccini , MAT-C, CCHP-A
In correctional facilities, access to health care often starts with a simple piece of paper—or an electronic message—known as a “sick slip” or “kite.” This formal request, submitted by an incarcerated individual, alerts health staff to a medical concern. Less formal but equally important are verbal requests made during med pass or while the nurse is rounding. These too should be treated as legitimate requests and not dismissed simply because they’re not in writing.
Health care staff collect sick slips daily, and triage begins by reviewing the nature of each complaint and assigning a priority level based on severity.
Nurses often rely on established clinical protocols to help guide triage decisions and, when appropriate, initiate treatment. Some concerns—like broken eyeglasses or notice of an upcoming release—may not require a face-to-face encounter. But any clinical complaint does. In those cases, a direct triage interaction with the patient must take place.
Face-to-face triage can occur in various settings. If the issue doesn’t require the patient to disrobe, it may take place in a designated room within the housing unit. More complex complaints warrant a clinical setting. Regardless of the location, privacy must always be ensured.
Once the patient is called to meet with health staff, their complaint should be addressed using clinical guidance protocols. The patient should clearly understand what treatment will be provided. If their condition is beyond the staff member’s scope of practice, they must be referred to a higher level of care—usually a provider. In urgent or emergent cases, such as chest pain, there should be no delays in connecting the individual with appropriate medical care.
Behind the scenes, the demands on providers and nursing staff are intense. Schedules are often fully booked, and urgent cases must be fit in wherever possible. This may mean rescheduling other appointments, potentially delaying care for someone else. Ideally, provider schedules would have buffer space for emergencies—but that’s rarely the reality in any health care setting, let alone corrections.
Understaffing only compounds the challenge. When a patient is rescheduled but not properly followed up, their care can fall through the cracks. Health teams must constantly balance limited resources with the need to provide timely and appropriate care.
One way to manage this delicate balance is by maximizing the use of the electronic health record (EHR) system. A well-utilized EHR can streamline scheduling, track appointments, automate reminders, and ensure that rescheduling and follow-up don’t get lost in the shuffle. This technology doesn’t just help health staff manage their time more effectively—it also helps ensure that incarcerated individuals receive the care they need when they need it.
Strong collaboration between health and corrections staff is essential to running an effective, responsive, and safe health care system within the facility. Timely care and prompt responses to urgent issues benefit everyone—especially the patients.
Custody staff and facility commanders play a critical role here. When they understand the purpose of the sick call system and support its function, it smooths the process for everyone involved. Appointing a dedicated liaison from custody to serve as a point of contact for the health team can also foster communication and coordination.
The sick call process is much more than a slip of paper—it’s the starting point for delivering meaningful health care behind the walls. Through coordinated teamwork, smart use of technology, and clear communication, correctional health systems can rise to the challenge. The goal is simple but essential: to ensure that every individual receives the care they need, when they need it.
Nancy Pieraccini, MAT-C, CCHP-A, is a lead consultant for NCCHC Resources and a longtime correctional health professional with expertise in developing well-organized correctional health care programs. She worked for more than 20 years at the Berkshire County Jail and House of Correction in Massachusetts, where as health services administrator she is responsible for the development and implementation of policies and procedures to support compliance with accreditation standards. Ms. Pieraccini is passionate about providing quality health care and treatment for patients with substance use disorders in correctional facilities. She is a lead surveyor for NCCHC’s health services and OTP accreditation programs, and is a member of the surveyor advisory committee. She also sits on the advisory board at McCann Technical School (MA) postgraduate program to introduce nursing students to correctional health care.