Wednesday, July 19, 2017

Veterans Affairs Office of Inspector General (OIG) in Washington, D.C., United States for Wednesday, 19 July 2017 "Clinical Assessment Program Review of the Lexington VA Medical Center, Lexington, Kentucky"

Veterans Affairs Office of Inspector General (OIG) in Washington, D.C., United States for Wednesday, 19 July 2017 "Clinical Assessment Program Review of the Lexington VA Medical Center, Lexington, Kentucky"
Veterans Affairs Office of Inspector General (OIG).
Clinical Assessment Program Review of the Lexington VA Medical Center, Lexington, Kentucky
The VA Office of Inspector General (OIG) conducted an evaluation of the Lexington VA Medical Center. This included key clinical and administrative processes that affect patient care outcomes—Quality, Safety, and Value; Environment of Care, Medication Management; Coordination of Care; Diagnostic Care; Moderate Sedation; Community Nursing Home Oversight; Management of Disruptive/Violent Behavior; and Mental Health (MH) Residential Rehabilitation Treatment Program (RRTP). OIG provided crime awareness briefings to 295 employees. OIG identified certain system weaknesses in utilization management; general safety and security; cleanliness; reusable medical equipment reprocessing and competencies; bloodborne pathogens training; anticoagulation policy, procedures, and competencies; transfer documentation; moderate sedation practices and training; community nursing home program oversight; disruptive/violent behavior management and training; MH RRTP privacy; and MH unit panic alarm testing. As a result of the findings, OIG could not gain reasonable assurance that: (1) Physician advisors document utilization management decisions; (2) The facility has effective reusable medical equipment reprocessing processes and a clean and safe reprocessing environment; (3) The Cooper Division maintains clean ventilation grills and monitors after-hours visitors; (4) Hemodialysis unit employees receive bloodborne pathogens training; (5) Anticoagulation policies include requirements, employees review quality assurance data, and competency assessments include all elements; (6) Transfer notes contain required elements; (7) Moderate sedation clinicians safely discharge outpatients and have current training; (8) Facility leaders monitor the community nursing home program; (9) Disruptive/violent behavior is managed, and employees receive training; (10) The facility maintains MH RRTP privacy and has a safe MH unit environment. OIG made recommendations in the following eight areas: (1) Quality, Safety, and Value; (2) Environment of Care; (3) Medication Management; (4) Coordination of Care; (5) Moderate Sedation; (6) Community Nursing Home Oversight; (7) Management of Disruptive/Violent Behavior; and (8) MH RRTP. OIG made a repeat recommendation for panic alarm testing.
Veterans Affairs Office of Inspector General (OIG).

Veterans Affairs Office of Inspector General (OIG)
801 I Street North West
Washington, D.C. 20536, United States
800-827-1000
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Veterans Affairs Office of Inspector General (OIG) in Washington, D.C., United States for Wednesday, 19 July 2017 "Healthcare Inspection – Quality of Care and Other Concerns Robert J. Dole VA Medical Center, Wichita, Kansas"
Veterans Affairs Office of Inspector General (OIG).
Healthcare Inspection – Quality of Care and Other Concerns Robert J. Dole VA Medical Center, Wichita, Kansas
OIG conducted a healthcare inspection at the Robert J. Dole VA Medical Center (facility) in Wichita, KS, in response to a July 15, 2015 request from former Congressmen Tim Huelskamp and Mike Pompeo to review mortality rates for patients transferred to the intensive care unit (ICU) and other quality of care concerns. VA Inpatient Evaluation Center (IPEC) is a program that measures and reports Veterans Health Administration (VHA) facilities’ quarterly mortality data. We found that the mortality rate for patients transferred from the inpatient medical/surgical unit to the ICU was not higher than other similar VA hospitals at the time of the congressional inquiry in 2015. During one quarter in 2014, we found the facility did not meet national VHA mortality rate benchmarks. We found that facility leaders were notified about the IPEC data, and consulted with VHA level program offices about practices and processes. During our July 21, 2015 unannounced site visit, we found one nocturnist physician working and did not observe doctors playing video games. Anesthesiology and surgery staff were required to return to the facility during off-hours within a specific timeframe if an urgent patient care need arose; however, for other attending physicians, we found that facility policy was not well-defined. We reviewed 28 ICU patients’ quality of care and did not find evidence of inadequate or inattentive care. During FY 2015 first 2 quarters, facility staff transferred 4 patients out of 668 ICU admissions to community hospitals. We found transfers were justified because facility medical services were unavailable. However, we found system deficiencies in VHA and facility policy compliance and identified a nocturnist coverage concern. Facility staff reported that the Emergency Department (ED) provider would leave the ED to perform intubations when mid-level providers, who could not perform emergency intubation, worked as nocturnists. We confirmed this practice when we reviewed one of the EHRs, which documented the ED provider performed an intubation outside of the ED. We recommended that the Facility Director implement recommendations from previous event-related reviews, strengthen Hospice/Palliative Care processes, assign Palliative Care Consult Team staff, assess the need to define the required timeframe for attending physicians to return to the facility, comply with facility policy for clinicians who perform emergency airway management, comply with VHA policies on ED coverage, and use qualified physician nocturnists.
Veterans Affairs Office of Inspector General (OIG).

Veterans Affairs Office of Inspector General (OIG)
801 I Street North West
Washington, D.C. 20536, United States
800-827-1000
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U.S. Department of Veterans Affairs in Washington, D.C., United States for Wednesday, 19 July 2017 "U.S. Department of Veterans Affairs CMV - News Update"

The Center for Minority Veterans is sharing recent news stories that may be of interest to minority Veterans, service members, and their supporters on a weekly basis.
07/18/2017 #VeteranOfTheDay Kenje Ogata
Today’s #VeteranOfTheDay is Army Veteran Kenje Ogata. Enlisting the day after the attack on Pearl Harbor, Kenje assumed that, having gone through the Civilian Pilot Training Program, he would have no trouble securing a spot on a bomber. [From VAntage Point]
We honor his service.
Solicitation of Nominations for Appointment to the National Research Advisory Council
The Department of Veterans Affairs (VA) is seeking nominations of qualified candidates to be considered for membership on the National Research Advisory Council (Council). Nominations for membership on the Council must be received no later than 5:00 p.m. EST on August 15, 2017. [From The Federal Register]
Student Veterans of America Set to Launch 2017 Chapter Leadership Academy
Aside from health care, education benefits may be VA’s most valuable offering to Veterans. The Post 9/11 G.I. Bill offers tuition, a book stipend, a housing allowance and more. [From VAntage Point]
07/17/2017 #VeteranOfTheDay Army Veteran Makissa Lewis
Today&rsq;s #VeteranOfTheDay is Makissa Lewis. Makissa served in the Army as a 92A Automated Logistical Specialist for 11 years. [From VAntage Point]
We honor your service, Makissa!
Solicitation of Nominations for to VA Prevention of Fraud, Waste & Abuse Advisory Committee
The Department of Veterans Affairs (VA) is seeking nominations of qualified candidates to be considered for appointment to the VA Prevention of Fraud, Waste, and Abuse Advisor Committee. Nominations for membership on the Committee must be received no later than 5:00 p.m. EST on July 24, 2017. [From The Federal Register]
At 111, Oldest WWII Veteran Visits Memphis for Documentary
Despite the swelling crowd that milled about, silence descended on the baggage claim area of Memphis International Airport this past Thursday as the most famous passenger on Flight 511 sat in a wheelchair posing for photos with strangers and accepting handshakes from children born a full century after he was. Richard Overton may not have expected the reception, but he was hardly fazed by it. [From The Washington Times]
Hundreds of Veterans to participate in National Veterans Wheelchair Games
Nearly 600 of the country’s best wheelchair athletes are arriving in Cincinnati, Ohio, for the 37th National Veterans Wheelchair Games July 17–22. “The Wheelchair Games is a great example of some of the finest athletes on the planet displaying true skill and determination,” said VA Secretary Dr. David J. Shulkin. [From VAntage Point]
Video Game Technology Helps Veterans Improve Their Balance, Get Moving
When 69-year-old Vietnam Veteran Robert Brown was looking for ways to increase his balance and physical activity, he joined VA’s Wii FitTM pilot research study at Little Rock, Ark. Motivated to lose weight, he overcame his concerns about falling and started walking and exercising again on a regular basis. [From VAntage Point]
07/13/20017 VeteranOfTheDay Army Veteran L. C. Netherly
Today’s #VeteranOfTheDay is L. C. Netherly. Netherly enlisted in the Army in 1941. In June of that year, after completing a night march; the soldiers of his company were swimming at the Baker Hollow Maneuver and Camping Site. [From VAntage Point]
We honor his service.
House to Act Quickly on Bipartisan Measure to Expand GI Bill
House Republicans and Democrats unveiled legislation Thursday that would provide the biggest expansion of college aid for military Veterans in a decade, removing a 15-year time limit to tap into benefits and increasing money for thousands in the National Guard and Reserve. [From Federal News Radio]
The US Isn't Ready To Stop Deporting Veterans Just Yet
“The issue of expanding eligibility to broader groups of veterans is something we very much want to do,” Veterans Affairs Secretary David J. Shulkin told BuzzFeed News, but not until ongoing VA issues are resolved. [From BuzzFeed]
Keep updated & let us know how we're doing.
VA does not endorse and is not responsible for the content of any external web site links. These sites are provided for informational purposes only.
Veterans Affairs.
Veterans Affairs.
If you are in crisis and need immediate help, please call 1-800-273-8255 and (PRESS 1) or visit http://www.veteranscrisisline.net/.
Please remember the only secure way to ask personal questions is at https://iris.custhelp.com.
VA benefits at explore.va.gov
US Department of Veterans Affairs
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Washington, D.C. 20420, United States
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Military Health System in Washington, D.C., United States for Wednesday, 19 July 2017 "Counter-hemorrhaging medical device saves service members' lives"

Counter-hemorrhaging medical device saves service members' lives
U.S. Army Spc. Courtney Natal provides aid to a simulated casualty. Born out of necessity on the battlefield, a new medical device is buying vital time for critically wounded patients in combat and in emergency care environments worldwide. (U.S. Army photo by Sgt. Harley Jelis)
BETHESDA, Md. — Born out of necessity on the battlefield, a new medical device is buying vital time for critically wounded patients in combat and in emergency care environments worldwide.
The device, known as a resuscitative endovascular balloon occlusion of the aorta, or ER-REBOA, was developed by Air Force Col. (Dr.) Todd Rasmussen, the associate dean for clinical research at the Uniformed Services University of the Health Sciences here, and Dr. Jonathan Eliason, associate professor of Vascular Surgery at the University of Michigan. The “ER” stands for “Eliason” and “Rasmussen.”
A new medical device, the resuscitative endovascular balloon occlusion of the aorta, or ER-REBOA, is buying vital time for critically wounded patients by helping stop hemorrhages in the pelvis and abdomen. (Courtesy photo)
From 2004-2007, the two surgeons were assigned together at Lackland Air Force Base in San Antonio and served tours at the military’s level III surgical hospital in Balad, Iraq. During their deployments, they both frequently saw combat trauma patients with critical injuries to the abdomen and pelvis -- areas where it can be nearly impossible to control hemorrhaging to save a patient’s life.
While tourniquets helped prevent service members from bleeding to death from wounds to their arms and legs, nothing existed for this part of the body. There was an urgent need for a solution, Rasmussen said, and he was sure there had to be a better way to help these patients.
Rasmussen said he and Eliason put their heads together and came up with an approach that wasn’t particularly new. Their idea was similar to the concept of a common endovascular procedure, cardiac catheterization, which is used to help treat a blocked artery or an aneurism by threading a catheter through a small incision in the groin and up through a vein or artery.
Controlling Bleeding
The two surgeons contrived a catheter with a small balloon at the end, which is inserted through a two- to three-millimeter incision near the groin and guided up through the femoral artery into the aorta. The balloon is then positioned to the desired level of the aorta and inflated with saline, blocking the aorta and cutting off circulation to the legs and pelvis, while still allowing blood to flow normally to the brain, heart, lungs and other vital organs.
This creates what could be described as an “internal tourniquet,” Rasmussen said, and helps temporarily stop severe blood loss in the pelvic and abdominal area. This can allow a patient to stabilize as they begin to receive blood products and are transported to a higher level of trauma care -- buying them critical time that they might not have had without the device.
“We had the vision for it, and we knew the elements of this approach worked very effectively for certain vascular disease conditions such as coronary artery disease and ruptured aortic aneurysms,” Rasmussen said.
In the following years, the surgeons were able to pair up with an entrepreneurial company that helped them create a more refined prototype. With the prototype, they conducted further research, producing data to demonstrate the device’s effectiveness, which led to it ultimately being patented jointly by the Defense Department and the University of Michigan.
Worldwide Use of Device
The device received Food and Drug Administration approval in November 2015. It’s become commercialized, and for the past year has not only been used in combat, but also in emergency and critical care environments worldwide. Bringing this to fruition has been a long and exciting journey but, Rasmussen said, their work is not yet complete.
The next steps are to continue researching the device’s effectiveness, explained Eliason, who retired from the military in 2007 and has since worked as a vascular surgeon at the University of Michigan. Today, the two doctors are conducting clinical studies to help determine which patients the device should be used on, which practitioners are best suited to administer it, when, and for how long. Like a regular tourniquet, Eliason said, the device cannot be left on permanently as that can cause damage, so it’s important to determine these factors.
Down the road, Rasmussen said he sees the device making an impact not only for trauma patients who are hemorrhaging, but also in post-partum hemorrhaging, during complicated pregnancies, to potentially help save a mother’s life during delivery. The device could also help save lives from a heart attack or cardiac arrest, possibly if used in conjunction with CPR, he added.
“We’re very excited about the potential of this technology,” Rasmussen said.
He credits the efforts of the entire team that worked to help make this possible, including DoD, the University of Michigan and the entrepreneurial private sector.
Rasmussen said the project also has been rewarding in a different way.
Aiding Patients
“It allows us to develop a technology that can potentially help hundreds of patients,” said Rasmussen, noting he’s heard from doctors around the world who are interested in using the device.
“That’s very gratifying on a different level.” he said, adding it’s rewarding to be part of something that may give providers a tool they can use effectively. Trying to save a patient who is losing significant amounts of blood, while looking for ways to control the blood loss, is very difficult, he said.
“I know that personally,” Rasmussen added.
Air Force Maj. (Dr.) Justin Manley also knows first-hand what it’s like to be in such a situation. In July 2016, while deployed as a general surgeon in support of operations in the Middle East, he faced a similar situation receiving a patient in near cardiovascular collapse, which is almost always fatal. He quickly made the decision to use the device, becoming the first surgeon to use it while in a combat setting. As a result of his actions, the patient survived.
“We were very excited to have the opportunity to be able to use the device because we understood its potential,” said Manley, who is assigned to a Special Operations Surgical Team in the 720th Operations Support Squadron at Hurlburt Field, Florida. SOSTs deploy far forward into hostile or austere areas to perform life-saving surgeries with little to no support from medical facilities or systems.
During that 2016 deployment, Manley said he and his team used the device four times. All four patients faced cardiovascular collapse and with the device, all four successfully made it through the operation to the next level of care, he said. Since then, the device has been used three more times on subsequent deployments by SOSTs, with the same effect.
It’s remarkable to have an opportunity to give patients another chance at life, Manley said.
Eliason shared the same sentiments.
“If this can save one life, then it will be worth it,” he said.
Disclaimer: Re-published content may have been edited for length and clarity. Read original post.
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