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VA Using Simple Fix to Improve E.R. Visits

Nurse interacting with a Veteran patient

VA is taking steps to ensure Veterans receive coordinated follow-up care following a visit to the E.R.

By Tom Cramer, Writer - VHA Digital Media
Tuesday, December 5, 2017

The Department of Veterans Affairs is employing a relatively simple fix to make sure Veterans receive the follow-up care they need after being treated in an emergency room.

Launched in 2015 at the Pittsburgh VA Medical Center, the Rapid Access Clinic model is currently being used at about 20 VA medical centers throughout the United States.

“Little tweaks to the system like this can sometimes result in major improvements to the care we give our Veterans.”

“We’d like to see every VA emergency room adopt this best practice during the next year,” said Dr. Susan Kirsh, VA’s national director for clinical practice management. “It’s simple, it’s not that hard to do, it’s effective and it doesn’t cost anything.  Most of all, it helps reduce the kind of fragmented care that afflicts so much of healthcare in this country today.”

So what, exactly, is the Rapid Access model? How does it work?

Kirsh explains: “You’re a Veteran and you walk into a VA emergency room with a broken wrist.  Our emergency room physician will treat you and make your wrist feel better.  But you also need follow-up care with a specialist, probably an orthopedic surgeon.  In the past we’d send you home from the E.R and tell you to make an appointment to see the specialist.  We were basically leaving it up to you.”

Kirsh said that’s how it usually works not just at the VA, but in private sector emergency rooms across the country. 

 

Dr. Susan Kirsh 

“Not anymore,” she said. “Now we’re going to schedule your three-day follow-up appointment right then and there in there E.R, before we send you home.  And equally important, our orthopedic surgeon will know you’re coming.  Our ER department has already sent her your information.  She knows you came into the ER on such-and-such a date with a broken wrist.  She knows how you broke your wrist.  She has your X-Rays.  She knows exactly what the ER doctor did for you.”

Kirsh described the Rapid Access model, also known as the Pittsburgh Model, as a relatively simple step toward achieving an elusive concept called coordinated care.

“Follow-up care with a specialist is so important,” she explained, “and getting Veterans in for prompt follow-up care is something we just haven’t been terribly efficient at. The Pittsburgh model fixes that.”

The Rapid Access Clinic model is the brainchild of Dr. Ali Sonel, VA Pittsburgh's chief of staff.

“With this model the specialist sees the patient quickly, within a few days at most,” he said. “We’ve streamlined the process.  Most importantly, we’ve taken the burden off the Veteran for arranging his or her own follow-up care.”

“The Pittsburgh model seems like such a simple procedural change, and I guess it is,” said Dr. Kirsh. “But little tweaks to the system like this can sometimes result in major improvements to the care we give our Veterans. And that’s what it’s all about.”