New Medical Procedures Unit implements performance improvement projects, earns 2024 team DAISY award

The new unit on the seventh floor was specially designed to accommodate various gastrointestinal procedures, such as endoscopies and colonoscopies, and pulmonary procedures, such as bronchoscopies.

The unit’s floor plan includes aspects that thoughtfully considered patient, family, caregiver, and staff experiences. It provides dedicated space with more room for procedures and recovery, ensuring continuous quality care to patients from preparation to completion of procedures.

“It’s really nice to see the environment match the care that we’ve always provided,” said Katy Charlton, the Medical Procedures Unit program manager. “On the 2nd floor, we were pretty cramped for space, and now just to see the area that we’re providing that same care in, it’s really nice to get the compliments. I’ve heard staff say it feels good now to be proud of our space, and it’s more welcoming for the Veterans too.”

The Medical Procedures Unit has eight rooms dedicated to pre-op and recovery – a substantial upgrade from the two rooms available in the old space on the second floor. Now, Veterans typically come back to the same room following their procedure, providing a space for families and caregivers to wait and receive updates from their physician rather than sitting in the lobby.

This is just one beneficial aspect of the new space. 

In addition to the extensive move, the Medical Procedures Unit integrated new leadership, implemented countless performance improvement projects, and expanded program services over the past year.

In recognition of their consistent commitment to adopting change centered around Veteran care, the Zablocki VA Health Care System presented the 2024 DAISY Award for Extraordinary Nursing Teams to the Milwaukee VA Medical Center’s Medical Procedures Unit.

The award was presented during a ceremony Feb. 14. The Medical Procedures Unit was selected as the winner out of 17 nominations. The award is designed to honor collaboration by two or more people, led by a nurse, who identifies and meets patient and/or patient family needs by going above and beyond the traditional role of nursing.

The MPU team has been working hard to ensure Veterans receive quality care in a timely manner.

“Historically, we did have a period of time where we had about 450 pending consults,” said Christine Ogrezovich, the Medical Procedures Unit’s assistant nurse manager. “We’ve improved that prior to us moving, but we’ve been sustaining live scheduling. We see anywhere between 20 to 30 consults a day.”

The Medical Procedures Unit looked for technological solutions, which led them to Jabber, a system that connects calling Veterans and caregivers with the first available scheduler, eliminating phone tag due to staff working and being unable to answer the phone.

“Since moving, we’ve implemented Jabber and our rate of scheduling consults has gone up,” Charlton said. “It’s essentially a portal that our RN schedulers here on the unit receive phone calls through.”

The unit also incorporated the VA’s Annie App into their service. Annie is a VA text messaging service that empowers Veterans to take an active role in their health care by sending various automated self-care reminders, such as reminders to take medication or instructions to prepare for health care appointments.

“Same-day cancellations, and in my opinion, avoidable cancellations, was a huge problem when I first started with medical procedures,” Charlton said. “Since implementing Annie App, we’ve noted about a 30% decrease in same-day cancellations.”

Expanded care, measurable results

“One advantage of moving here is that when we moved here, we could plan it,” said Dr. Kulwinder Dua, one of the Milwaukee VA’s gastroenterology section chiefs.

The new procedure rooms in the MPU provide more space and expanded opportunities for Veteran care through the GI and pulmonary programs.

“Some of our new equipment we couldn't get into the old room, so we had to actually try and get the operating room scheduled,” said Dr. Uzair Ghori, the Milwaukee VA’s interventional pulmonary director. “That was an extra layer that made scheduling so much more difficult. Now since we have our own space, that equipment fits.”

With less space and scheduling constraints, the volume of more complicated pulmonary procedures performed has at least doubled since moving to the seventh floor.

In December 2024, the pulmonary team completed their 100th robotic bronchoscopy procedure. This represents only one of several advanced pulmonary procedures available at the Milwaukee VA.

“This achievement reflects our collective commitment to providing Veterans with the highest standard of pulmonary care through cutting-edge technology,” Ghori said.

As an academic medical center, the state-of-the-art unit also provides a unique opportunity for education without adding more people to rooms that may already be a tight fit due to necessary staff and equipment for procedures.

“If we're doing some very unusual, complex case and a lot of people want to see it, the room used to get very crowded,” Dua said. “Now we have the room views projected into the doctor's room. If a physician is doing a complex case in the procedure room, I can sit with the fellows over here and show them what’s going on.”

According to Dua, streaming is only done internally on the unit with safeguards in place to protect patient information and maintain confidentiality, ensuring that only appropriate staff can view procedures for approved purposes.

The new space has vastly improved efficiency, he said.

“With limitations of two admitting room downstairs, recovery somewhere else, also with limited rooms, and certain procedures that require two hours like draining fluid out from the abdomen locking up the room, the rhythm was lost,” Dua said about gastroenterology’s previous space. “Even if we have the same number of patients scheduled, it became chaotic as we go along during the day.

“Now, over here, we are more on time. And those additional procedures like manometries and ascitic paracentesis are no longer tying up our rooms. There are now special rooms we have made for that. This is the advantage of designing this ourselves when we remodeled. So the special procedure room is quite separate. It doesn't interfere with any endoscopy rooms. And that keeps our schedule on track.”

As the Medical Procedures Unit continues to remain flexible and expand services beyond their program level, their top focus always has been – and continues to be – caring for Veterans.

“We’re excited to offer more care now, new procedures, expanded scheduling capabilities, more space,” said Kristin Olson, the nursing education coordinator for medical procedures. “We’re excited to be able to do more for Veterans.”