"Surprise: VA hospitals get high marks"

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Huh.

"Surprise: VA hospitals get high marks"

The Walter Reed scandal shouldn't obscure the truth that VA hospitals deliver solid, innovative care. By Betsy McCaughey, BETSY MCCAUGHEY is chairman of the Committee to Reduce Infection Deaths (hospitalinfection.org).
April 2, 2007

THE TYPICAL hospital patient is given the wrong medication or the wrong dose at least once a day, according to the Institute of Medicine, a research organization that advises Congress. The good news is that these mistakes are less likely to happen at a hospital run by the Department of Veterans Affairs.

Surprised?

Recent news accounts about the shameful conditions at Walter Reed Army Medical Center — a hospital unaffiliated with the Department of Veterans Affairs — might lead you to believe that VA hospitals are a national embarrassment. That may have been true at one time. But VA hospitals have undergone a remarkable turnaround in the last decade and, on average, earn higher marks for patient safety and quality of care than most other hospitals in the United States.

For example, the VA system is well ahead of most hospitals in protecting patients from medication errors. The VA has adopted a system in which a nurse scans a barcode printed on the patient's bracelet, indicating the name and dose of each medication the patient should be getting. The nurse then scans the pre-packaged medication to make sure it's a match.

Another new technology — computer physician order entry (or CPOE) — is designed to stop doctors from prescribing the wrong medication. With CPOE, a doctor enters the prescription at a computer terminal instead of scribbling it on a pad. The computer identifies incorrect doses or a medication that conflicts with other meds the patient is taking. If the computer sounds an alarm, the physician has to override it. In Australia, Britain, New Zealand and much of Western Europe, hospitals have adopted CPOE, but most U.S. hospitals have resisted. An exception is the VA, which has installed CPOE nationwide.

The VA has also pushed ahead of most hospitals in the U.S. by investing in electronic medical records, allowing a patient's medical history to be accessed in a few seconds. The VA database is a resource for medical researchers and the envy of the private sector.

Dr. James Bagian, director of the National Center for Patient Safety at the Department of Veterans Affairs, points out that the VA is a leader in safety initiatives ranging from preventing injuries related to falls to fighting one of the most feared, drug-resistant hospital infections, methicillin-resistant Staphylococcus aureus. In 2002, the VA Pittsburgh Healthcare System launched a pilot program that reduced such infections a stunning 85% by enforcing meticulous hand hygiene, patient screening and precautions against spreading bacteria on gloves, clothing, wheelchairs and stethoscopes. The VA is instituting the same approach nationwide.

Patients in VA hospitals are also more likely to receive optimal care than patients in other hospitals. In the late 1990s, the VA re-engineered its healthcare system, using information technology to track and measure the care each patient is given. The result is significantly higher compliance with best practices.

According to a 2003 study in the New England Journal of Medicine, patients in VA hospitals received better care in 12 out of 13 measures compared to Medicare-eligible patients in nongovernment hospitals. Measures included care for diabetes, depression and congestive heart failure and cancer screenings. The American Customer Service Satisfaction Index (based at the University of Michigan) shows that patients in VA hospitals are more satisfied with their care (84% vs. 74%) than patients in private-sector hospitals.

Not all 1,400 hospitals operated by the Department of Veterans Affairs are models of excellence. A recent internal VA report acknowledged that some hospitals need repair because of mold, leaky roofs or defective plumbing. Recent studies have revealed substandard conditions at three VA hospitals around the country.

But the news about Walter Reed, which has been exacerbated by attack politicians from both parties, should not obscure the truth about the standard of care for most veterans. Facility shortcomings aside, the VA delivers better care than most hospitals.

http://www.latimes.com/news/opinion/la-oe-mccaughey2apr02,0,3030928.story?coll=la-opinion-rightrail

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Facility shortcomings aside, the VA delivers better care than most hospitals.

http://www.latimes.com/news/opinion/la-oe-mccaughey2apr02,0,3030928.story?coll=la-opinion-rightrail

From what I understand, that is if you can get them in the system and in the door. I have no personal experience, only starting my second year, (so flame on!), but from what I've READ on this forum is that their electronic records are quite good, and much better than AHLTA. I am not looking forward to AHLTA, I also am not really looking forward to doing a rotation at a VA, and we have one with our school, but that is for patient reasons. I probably should and probably will to get a broad scope of the different health care delivery systems. 1. the MED, the regional trauma center that is always fighting funding issues because you have to treat uninsured in the ER, 2. The VA 3. MILMED, and 4. The private or research hospital, Le Bonheur children's and St. Jude's. Guess I'll be better informed in two years, if not too cynical to reply.

Thanks for the article, gives great ideas for process improvement I can use in my third year clerkship aimed towards same thing.
 
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If you know how to "word the question", you can get whatever answer to whatever survey you want.

combine that with them fact that patients DO NOT KNOW the exact quality of care they are receiving and you end up with a survey that has the specificity and sensitivity of a coin flip.

Now I can't speak directly about the VA, as I have no first hand experience there, but I saw numerous USAF surveys that were more "lies and deception" than acurate representation.
 
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I have worked in the VA system as a healthcare provider. Although the VA has unique problems that are not found in the civilian world, I agree that for the most part veterans are getting high quality care.

I think the two main problems are:

1. Getting in the door, as one poster pointed out already. When I was there, the VA was opening its doors to veterans without service connected disabilities who had private health insurance. They were given access to care at the VA for a $50 co-pay (you could schedule as many appointments as you wanted for the same day and still pay only $50). So many veterans who didn't really need the care signed up that it created months and months of waiting for those who did.

Keep in mind that just about any condition can be service connected. Someone who develops diabetes in the service can get the same rating as an amputee, TBI, SCI, or veteran with chronic pain. It may be just me, but I think those with physical and psychological issues should be given priority.

2. GS employees. As most of us know, they are near impossible to fire. I found that in general, the RN's I worked with were superb. The LPN's and most of the CNA's, not so much. This can really slow down efficiency and quality.

So yes, there are problems in the system and there are problem employees. But found a huge number of dedicated, hard-working, and caring physicians, nurses, therapists, and psychologists who all did their best to provide top quality care to our veterans. Most of us knew how to "work the system"
to the veteran's advantage and all of us did just that.
 
I've recieved pretty good care at the VA, but it's a small town.

I don't get a lot of baby talk, they don't have an expresso bar, and they didn't have time to hear about my inner child, but I recieved what I needed and it was free.
 
There's a lot of variability between individual VA's too. While all share the same computer systems, the quality of personnel and level of care varies quite a lot from one place to another.
 
For the uninitiated, what would be the rationale for pushback on CPOE systems?
 
I would think cost. It's expensive to get a system up and running and expensive to train physicians and other staff to use it.
 
I would think cost. It's expensive to get a system up and running and expensive to train physicians and other staff to use it.
After thinking a bit, I think we're one of the few decentralized providers of health care. It's a hell of a lot easier to tell what a patient's been prescribed when all prescriptions are entered into the same data warehouse, and are dispensed from the same pharmacy system. Makes CPOE exponentially more difficult to implement if done on numerous systems.
 
While the VA has the same issues with lazy support staff, oppressive bureaucracy and sometimes poor facitilties, in other respects they are light years ahead of current active-duty hospitals. Many of the larger VA hospitals have robust partnerships with nearby universities, and the VA medical staff may include some of the brightest, most experienced clinicians in the country (even if they only work there part-time). There is a wealth of interesting pathology at virtually every VA which includes a diverse population ranging from young Iraq war vets to WWII vets in their 80’s—great for teaching residents. And they also run large randomized trials that absolutely dwarf any clinical study in the DoD. In my field, the VA has run landmark randomized trials for carotid endarterectomy and endovascular AAA repair. And although I don’t know the specifics, I understand that compensation packages and retirement benefits make way more sense in the VA than on the active-duty side. Practicng clinicians also seem to have a little more say in the way their clinics are run than in the typical USAF clinic. Depending on the university affiliation, the VA can be a good start to an academic career. Frankly, I would much rather be working at the VA
 
I'd also like to say that I think the rehab services provided by the VA are superb. WRAMC and BAMC do a lot of general rehab and amputee rehab but mostly send SCI and TBI directly to the VA system once they are ready to begin inpatient rehab. These veterans stay in rehab, with full support services and full physical/occupational/speech therapy services for as long as they need until they are functioning at or near their maximum potential. I've even seen patients kept in rehab even after they have met their goals to give contractors more time to modify their house with ramps, stair lifts, roll-in showers, etc. That would never happen in the civilian world.

One memorable Marine I worked with was a patient of mine in SCI rehab for well over a year before he was discharged. These vets get not just one but TWO custom prescribed wheelchairs to go home with; many of them get home modifications and wheelchair vans free of charge. And of course all their care for the rest of their lives is free and they will continue to get their equipment and wheelchairs serviced and replaced every 5 years for free.

The VA may be doing some things wrong, but they sure are doing some things right and I wish the media would talk about it more.
 
I think the two main problems are:

1. Getting in the door ...

2. GS employees ...

I'm currently fighting with the nearby VA to get one of my guys seen there. The maze of bureaucracy is incredible. They must give PhD level courses in the runaround to all VA employees. This seems to be perpetuated by #2, since their sole objective is doing as little work as possible while collecting their government cheese every two weeks.
 
NO SURPRIZE: While I am sure it shocks many on here, this really isn't a surprize. The VA has consistently rated as one of the top health care organizations in the United States for almost the past decade. Look it up. They are always near the top.
 
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