Federal practitioner : for the health care professionals of the VA, DoD, and PHS最新文献

{"title":"Establishing a Just Culture: Implications for the Veterans Health Administration Journey to High Reliability.","authors":"Keith Essen, Christy Villalobos, Gary L Sculli, Luke Steinbach","doi":"10.12788/fp.0512","DOIUrl":"10.12788/fp.0512","url":null,"abstract":"<p><strong>Background: </strong>To establish a culture of safety and improve patient care, the Veterans Health Administration (VHA) is identifying and implementing necessary parameters and objectives across the health care landscape to enhance services on its journey to becoming a high reliability organization (HRO).</p><p><strong>Methods: </strong>This quality improvement initiative sought to increase the understanding of factors that influence the establishment and sustainment of a just culture and identify specific methods for improving their implementation. Focus groups of HRO leads at 16 VHA hospital facilities identified emergent themes, facilitators, and barriers to maintaining a just culture and developed recommendations for enhancing both psychological safety and accountabilitity.</p><p><strong>Results: </strong>The study identified the 5 key facilitators, barriers, and recommendations most frequently mentioned by HRO leads during focus group sessions. Implementing these strategies can potentially improve care standards and patient outcomes. Successfully integrating these recommendations demands consistent dedication, cooperation, and effort from stakeholders across all system levels, accompanied by regular evaluations to fortify the just culture principles.</p><p><strong>Conclusions: </strong>This study offers an enriched perspective on initiating and sustaining a just culture and the broader application of HRO principles in health care. The methodology can act as a blueprint for broader HRO integration in the VHA and other institutions, particularly when paired with continuous quantitative evaluation of safety culture, just culture practices, and patient outcomes.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 9","pages":"290-297"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short Interval Repeat Colonoscopy After Inadequate Bowel Preparation Is Low Among Veterans.","authors":"Nicha Wongjarupong, Vijay Are, Anders Westanmo, Jenson Phung, Richie K Huynh, Tessa Herman, Nancy R Murphy, Mohammad Bilal, Susan M Lou, Brian Hanson","doi":"10.12788/fp.0510","DOIUrl":"10.12788/fp.0510","url":null,"abstract":"<p><strong>Background: </strong>Adenoma detection rate and interval colon cancer rates are associated with bowel preparation quality. The US Multisociety Task Force recommends repeat colonoscopy for individuals with inadequate bowel preparation (IBP) within 1 year. However, little is known regarding the rate and associated factors of repeat colonoscopy after IBP.</p><p><strong>Methods: </strong>Individuals undergoing colonoscopy for screening, surveillance, positive fecal immunohistochemistry test, and virtual colonoscopy at the Minneapolis Veterans Affairs Medical Center from January 2016 to October 2021 were included. IBP was classified based on Boston Bowel Preparation Scale score or Aronchick scale.</p><p><strong>Results: </strong>A total of 10,466 individuals were included, of which 571 (5.5%) had IBP. Repeat colonoscopy within 1 year was recommended for 485 individuals (84.9%); 287 (59.2%) were completed within this time period and 126 (26.0%) never underwent repeat colonoscopy. Proximity to the endoscopy center was associated with a higher rate of repeat colonoscopy within 1 year (61.7% vs 51.0%, <i>P</i> = .02). Current smoking status was associated with a lower rate of repeat colonoscopy within 1 year (25.8% vs 35.9%, <i>P</i> = .02). There were no differences in age, sex, race, inflammatory bowel disease diagnosis, or opioid or anticoagulation use with adherence to repeat colonoscopy within 1 year. There was no difference in adherence to a timely repeat colonoscopy from 1 year before the COVID-19 pandemic (58.9%) vs 1 year postpandemic (59.9%).</p><p><strong>Conclusions: </strong>The rate of IBP was 5.5%. Only 59.2% of those with IBP underwent recommended repeat colonoscopy within 1 year, and 26.0% never underwent repeat colonoscopy. Additional efforts are needed to ensure that individuals with IBP return for timely repeat colonoscopy.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 9","pages":"306-311"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of a Splenic Abscess as the Origin of Illness in Exudative Pleural Effusion.","authors":"Madison Demmer, Mitchell Clark, Tayler Acton, Nikhil Seth","doi":"10.12788/fp.0509","DOIUrl":"10.12788/fp.0509","url":null,"abstract":"<p><strong>Background: </strong>Pleural effusion, the presence of fluid within the pleural space, is a common condition secondary to a wide range of pathological causes. Splenic abscess, which is rare, has previously been described as a cause of exudative pleural effusion. Splenic abscess is thought to be associated with bacteremia, iatrogenic inoculation, or hematogenous spread from another bacterial focus. However, there are no documented cases of pleural effusion with the spleen as the source of infection.</p><p><strong>Case presentation: </strong>An 80-year-old male presented with shortness of breath, weight loss, and fever. Imaging revealed a left pleural effusion and a splenic mass. Following several unsuccessful attempts to drain the effusion, attention shifted to the splenic mass, which proved to be a bacterial abscess. After targeted antibiotic treatment for the splenic abscess and surgical decortication for pleural adhesions, the patient showed significant improvement and was discharged.</p><p><strong>Conclusions: </strong>This clinical scenario underscores the importance of identifying and addressing the source of pleural effusion, including consideration of splenic abscess as the primary process. By process of exclusion, we determined that the spleen was the origin of the disease, challenging the conventional perception of the spleen as exclusively a secondary locus of infection, without direct iatrogenic inoculation or bacteremia. The patient's presentation, hospital course, and response to treatment should encourage clinicians to consider a wider range of differential diagnoses for the primary pathologies underlying pleural effusions, facilitating earlier identification and intervention.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 9","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rebuilding of Military Medicine.","authors":"Cynthia M A Geppert","doi":"10.12788/fp.0514","DOIUrl":"10.12788/fp.0514","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 9","pages":"266-267"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Colorectal Cancer Screening via Mailed Fecal Immunochemical Testing in a Veterans Affairs Health System.","authors":"Jin Xu, Jeffrey Kravetz, Juliette Spelman, Kimberley Roy, Vincent Lilly, Danielle Cosentino, Christopher Ruser","doi":"10.12788/fp.0496","DOIUrl":"https://doi.org/10.12788/fp.0496","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer screening rates at the Veterans Affairs Connecticut Healthcare System (VACHS) decreased during the COVID-19 pandemic. Fecal immunochemical testing is recognized as a tier 1 preferred screening method by the US Multi-Society Task Force on Colorectal Cancer. The VACHS implemented a program that mailed fecal immunochemical testing kits to patients to improve colorectal cancer screening rates.</p><p><strong>Observations: </strong>This article describes the components of the VACHS patient aligned care team-based mailed fecal immunochemical testing program. Fecal immunochemical testing utilization, completion, and colorectal cancer screening rates at VACHS substantially increased after the implementation of this project.</p><p><strong>Conclusions: </strong>Through a proactive, population-based colorectal cancer screening program centered on mailed fecal immunochemical testing kits outside of a traditional patient visit, VACHS substantially increased the utilization of fecal immunochemical testing kits as well as colorectal cancer screening rates.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 3","pages":"S39-S42"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overuse of Hematocrit Testing After Elective General Surgery at a Veterans Affairs Medical Center.","authors":"Anthony Vigil, Taylor Parnall, Clifford Qualls, Robert Glew, Robin Osofsky, Micah Guess, Lauren Mercer","doi":"10.12788/fp.0479","DOIUrl":"https://doi.org/10.12788/fp.0479","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical usefulness and costs of routine postoperative hematocrit testing after elective general surgery.</p><p><strong>Methods: </strong>We reviewed charts of all patients who had elective general surgery at New Mexico Veterans Affairs Health Care System, Albuquerque hospital from 2011 through 2014. Demographic data and patient characteristics (eg, comorbidities, smoking/drinking history), estimated blood loss (EBL), pre- and postoperative hematocrit levels, and signs and symptoms of anemia were compared in patients who did or did not receive a blood transfusion within 72 hours of the operation.</p><p><strong>Results: </strong>Of 1531 patients who had an elective general surgery between 2011 and 2014, ≥ 1 postoperative hematocrit levels were measured in 288 individual patients. There were 1312 postoperative hematocrit measurements before discharge (mean, 8.7; range, 1-44). There were 12 transfusions (0.8%) for patients without moderate to severe pre-existing anemia (hematocrit < 30%). Five of 12 transfused patients received intraoperative transfusions and 7 patients were transfused within 72 hours postoperation. No patients were transfused preoperatively. Of 12 patients receiving transfusion, 11 had EBL > 199 mL and/or signs of anemia. Risk factors for postoperative transfusion included lower preoperative hematocrit, increased EBL, and having either abdominoperineal resection or a total proctocolectomy.</p><p><strong>Conclusions: </strong>Routine postoperative hematocrit measurements after elective general surgery at US Department of Veterans Affairs medical centers are of negligible clinical value and should be reconsidered. Clinical judgment, laboratory-documented pre-existing anemia, a high-risk operation, or symptoms of anemia should prompt monitoring of patient postoperative hematocrit testing. This strategy could have eliminated 206 initial hematocrit checks over the 4 years of the study.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 3","pages":"S26-S32"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Management Board Implementation to Enhance High Reliability at a Large VA Health Care System.","authors":"Jessica I Gupta, Stacy Sivils, James Reppert, Wendy Paulot, Nathan Houchens, Scott Hummel","doi":"10.12788/fp.0507","DOIUrl":"https://doi.org/10.12788/fp.0507","url":null,"abstract":"<p><strong>Background: </strong>The US Department of Veterans Affairs (VA) is committed to embodying principles of high reliability organizations and Lean management culture. The practice of making problems readily known to team members and leadership is called visual management, an important tool in the journey to becoming a high reliability organization. Visual management boards (VMBs), or huddle boards, can foster transparency, teamwork, and employee empowerment.</p><p><strong>Observations: </strong>A variety of health care teams at the Lieutenant Colonel Charles S. Kettles VA Medical Center within the VA Ann Arbor Healthcare System (VAAAHS) created and instituted VMBs. This article highlights the implementation in a large, diverse outpatient cardiology clinic. The incorporation of a VMB into the daily huddle of the outpatient cardiology clinic team led to increased problem identification among staff and leadership and fostered teamwork as issues were addressed. Feedback from teams across the VAAAHS noted how the boards were helpful in prioritizing areas for improvement, fostering teamwork, and increasing staff engagement, empowerment, and satisfaction.</p><p><strong>Conclusions: </strong>A VMB is a simple, inexpensive, yet potentially powerful tool to bring together diverse health care teams to identify problems in the workplace, engage staff in developing solutions, and enhance communication with leadership. Implementation of VMBs at the VAAAHS may serve as a model for other VA health care systems for the incorporation of visual management into daily workplace culture.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 8","pages":"242-246"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Crisis in Scope: Recruitment and Retention Challenges Reported by VA Gastroenterology Section Chiefs.","authors":"Erik C von Rosenvinge, Stacie A Vela, Elizabeth R Paine, Michael F Chang, Brian J Hanson, Tamar Taddei, Walter E Smalley, Kerry B Dunbar, Nabeel H Khan, Lyn Sue Kahng, Jennifer Anwar, Robert Zing, Andrew Gawron, Jason A Dominitz, Gyorgy Baffy","doi":"10.12788/fp.0504","DOIUrl":"10.12788/fp.0504","url":null,"abstract":"<p><strong>Background: </strong>Having a sufficient number of gastroenterologists is important for protecting the digestive health of veterans. However, gastroenterology is among the most difficult medical specialties for recruitment at the US Department of Veterans Affairs (VA).</p><p><strong>Methods: </strong>We surveyed VA gastroenterology section chiefs to learn about current barriers to recruitment and retention and to identify opportunities for improvement.</p><p><strong>Results: </strong>Of 131 VA gastroenterology section chiefs at VA medical centers who received the survey, 55 responded (42%). Thirty-six respondents (65%) reported current vacancies at their facilities (range, 1-4). Low salary and human resources challenges were the most frequently reported barriers to recruitment. Low salary and administrative burden, including lack of sufficient support staff, were the most frequently reported barriers to retention.</p><p><strong>Conclusions: </strong>While salary is the most frequently reported barrier to recruitment and retention, human resources challenges represent the second-most frequently reported barrier to recruitment. Administrative burden linked to suboptimal staffing support is the second most frequently reported barrier to retention. Efforts to raise salaries (higher than the current $400,000 ceiling), streamline human resources processes, and reduce administrative burden are needed to ensure a thriving VA gastroenterology workforce.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 8","pages":"256-260"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of VA Hematology/Oncology Clinical Pharmacy Practitioners in the Review of Community Prescriptions for Specialty Medications.","authors":"Katherine Kelly, Hannah Spencer","doi":"10.12788/fp.0497","DOIUrl":"https://doi.org/10.12788/fp.0497","url":null,"abstract":"<p><strong>Background: </strong>Within the US Department of Veterans Affairs (VA), eligible veterans can receive covered health care through the community care network. Many prescriptions for specialty medications made by community care prescribers are filled by outpatient VA pharmacies. Trained hematology/oncology clinical pharmacy practitioners (CPPs) review specialty medication prescriptions from community-based prescribers. This study's primary objective was to evaluate clinical interventions initiated by hematology/oncology CPPs at the Veterans Affairs North Texas Health Care System (VANTHCS) during their review of hematology/oncology specialty prescriptions from community care prescribers.</p><p><strong>Methods: </strong>A retrospective chart review of VANTHCS patients enrolled in the community care program with a specialty hematology/oncology prescription received and reviewed by a VA clinical hematology/oncology CPP was conducted for records from January 1, 2015, to June 30, 2023. The primary outcome was the number and types of clinical interventions. Secondary outcomes include the number of interventions accepted and/or denied by the prescriber and the financial implications of these interventions.</p><p><strong>Results: </strong>Two hundred twenty-one specialty hematology/oncology prescriptions met the study inclusion criteria. VANTHCS hematology/oncology CPPs completed clinical interventions for 82 prescriptions (37%). Among those prescriptions, CPPs documented 97 clinical interventions. The most commonly documented interventions included managing/preventing a drug interaction (26%) and dose adjustment requests (25%).</p><p><strong>Conclusions: </strong>Hematology/oncology CPPs at VANTHCS are essential in reviewing anticancer medication prescriptions from community-based practitioners ; CPPs completed clinical interventions for more than one-third of the prescriptions and prescribers approved most of these interventions.</p>","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 Suppl 3","pages":"S15-S18"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Has the VA Fulfilled its Commitment to Trust and Healing?","authors":"Cynthia M A Geppert","doi":"10.12788/fp.0508","DOIUrl":"https://doi.org/10.12788/fp.0508","url":null,"abstract":"","PeriodicalId":94009,"journal":{"name":"Federal practitioner : for the health care professionals of the VA, DoD, and PHS","volume":"41 8","pages":"234-235"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11473032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}