VA Puget Sound Health Care System
2018 a great year for VA Puget Sound
- VA Puget Sound Health Care System delivered on commitment to provide world-class care to the more than 110,000 Veterans it cares for
- VA Puget Sound researcher received 2018 William S. Middleton Award—VA’s highest research award for Biomedical Science
- Access to care expanded with more than 50 areas available via telehealth
- Innovative programs launched to meet the complex needs of Veterans with co-occurring pain, substance use disorder and mental-health concerns, while reducing dependence on opioids
SEATTLE, WA – January 30, 2019 – As the largest integrated health care system in the country, the VA not only cares for our nation’s heroes, but is in a unique position to advance change and positively disrupt the way America delivers health care. VA Puget Sound Health Care System is making a significant difference, and its staff across its nine facilities throughout the Pacific Northwest, have much to be proud of.
“Caring for our nation’s Veterans is paramount to VA. When it comes to their care and treatment, our goal is simple: we want to empower Veterans and their families to engage in their own whole health journey, built on safe, timely and excellent quality care,” said Michael Tadych, VA Puget Sound director. “We strive to do everything possible to ensure all Veterans entrusted to us for care live longer, safer and healthier lives.”
In fiscal year 2019, VA Puget Sound staff—almost 3,600 health care providers and non-clinical staff—supported more than 1 million outpatient visits. Of those, almost 78 percent of those patients received an appointment within seven days of their preference. Additionally, approximately 6,100 surgeries were performed and 6,500 Veterans received care as inpatients at its Seattle medical center.
And perhaps one of the best indicators of how well VA Puget Sound is delivering that care is its move to a 3-star facility in overall quality thanks to the hard work of the entire VA Puget Sound team. It has seen improvements consistently over the past two years, and 78 percent of its quality measurements improved as compared to the previous year. For example, hospital readmissions and mortality (death) rates were so low that it ranked better than 90 percent of the other VHA facilities nationally. Add to that, the fact VA was ranked 6th Best Place to Work among large Federal Government agencies (https://bestplacestowork.org/rankings/overall/large) based on 2018 employee survey results and it becomes easy to see why 2018 was a great year!
Highlighting some of the many achievements and milestones throughout the year, VA Puget Sound now offers more than 50 areas of care through telehealth services—from mental health, pain and podiatry to amputee and lung transplant care. In 2018, more than 17,000 Veterans accessed this method of care, reinforcing the many steps the health care system is making to improve access to care, and make it more convenient.
Along with caring for the more than 110,000 Veterans enrolled with a primary care manager at one of its nine facilities, VA Puget Sound also provides specialized care to Veterans in an expanded five-state area in the Pacific Northwest through its four regional hubs: Regional Amputation Center, Regional Spinal Cord Injury Hub, Marrow & Lung Transplant Unit and Polytrauma Network Site. For example, the VISN 20 Polytrauma Network Site (PNS) located at VA Puget Sound is part of an integrated network of specialized rehabilitation programs dedicated to serving Veterans and service members with both combat and civilian related traumatic brain injury (TBI) and polytrauma. The PNS provides post-acute interdisciplinary rehabilitation services, consultation and training, and is a referral site for other Polytrauma programs across Alaska, Washington, Oregon and Idaho. During fiscal year 2018, PNS had 95 Veterans with a history of moderate-to-severe TBI enrolled for lifetime care and case management. An additional 126 Veterans with a history of mild TBI completed short-term rehabilitation in the Polytrauma program and were discharged from care, and PNS received over 300 referrals for concussion/TBI screening evaluations.
VA Puget Sound’s Spinal Cord Injury (SCI) Service provides rehabilitation as well as specialized medical, surgical and primary care for Veterans with new and chronic spinal cord injuries. As the regional hub site for eight VA health care systems in Veterans Integrated Service Networks 20 and 19 (which encompasses the Pacific Northwest and Rocky Mountains), more than 750 Veterans living with SCI received care during fiscal year 2018. Its SCI Service has developed programs to promote recovery of walking. Plus, last year, staff received training in use of a powered exoskeleton worn around the waist and legs, allowing eligible Veterans with spinal cord injuries to stand and walk. The team also acquired a dynamic body weight support harness, the Bioness Vector Gait and Safety System, to help Veterans improve mobility and balance.
Staff at VA Puget Sound also helped lower dependency on opioids—a national problem both inside and outside of VA that has claimed the lives of more than 200,000 people in the U.S. from 1999 to 2016—by alleviating a Veteran’s pain using evidence-based, non-prescription methods of treating pain. Evidence-based alternative pain treatments are not always readily available in rural areas, where Veterans’ access to specialty pain services is reduced by geographic features, limited mobility, co-occurring medical challenges and other complex barriers, so intervention there is especially important. Through its Pain Telehealth pilot program at four of its Community Based Outpatient Clinics (CBOCs) in Bremerton, South Sound, Mount Vernon and North Olympic Peninsula, VA Puget Sound expanded services to better connect with Veterans in rural areas. What’s more, it is expected to include a TelePain Program through video teleconferencing to all its CBOCs and eligible Veteran homes in the four-state region. Once fully implemented, the program will include treatment options that include pain education classes, group psychotherapies for pain, acupuncture education, yoga and tai chi, and opioid safety interventions.
“Our goal with our TelePain Program is to reduce Veteran suicide risk, increase opioid safety and access to care, while reducing travel burden,” said Tadych. “The program also seeks to increase collaboration among VA clinicians across departments and sites, to enhance the coordination for Veterans with complex treatment needs—including opioid tapering.”
Along with caring for the physical needs of its patients, VA Puget Sound’s laser focus on ensuring the mental health care and well-being of its Veterans is clear. In fiscal year 2018 alone, it supported mental health care needs for more than 23,000 of its Veterans with almost 236,500 encounters across its wide array of services that include acute inpatient, residential, ambulatory care, addictions treatment, emergency and urgent care, and vocational rehabilitation. Additionally, its Suicide Prevention Team members assisted approximately 2,500 Veterans, their families and their concerned friends located around the Puget Sound region.
“Our mission is to provide an appropriate level of support and treatment to assist Veterans in recovery from mental health and addictive disorders and to maximize their overall level of function and satisfaction with life,” said Tadych. “Care is patient-focused, culturally sensitive and supported by our clinical, education and research programs.”
Mental health and suicide prevention programs and services range from inpatient, psychiatric care with acute substance abuse detoxification and residential rehabilitation programs to address substance use disorders and post-traumatic stress disorder, to evidence-based, individual, family and group psychotherapy for the evaluation and treatment of mental health disorders. Primary care teams at its main medical centers and throughout its CBOCs are supported by onsite mental health staff including psychiatrists, psychologists, social workers, nurse practitioners, nurses, technicians and peer support staff, who work together to provide care. Additionally, many of the mental health services at VA Puget Sound are offered via telehealth to Veterans who receive care at one of its seven CBOCs or at non-VA locations such as Veterans’ homes. Telehealth equipment with Internet access can be provided to Veterans as needed at no cost.
VA Puget Sound not only cares for our nation’s heroes, but is in a unique position to advance change and positively enhance the way America delivers health care. And the common thread driving this change across VA Puget Sound is the passion, commitment and thought-leadership of its diverse team.
William Banks, VA Puget Sound’s associate chief of staff for Research and Development, received the 2018 William S. Middleton Award—the highest honor conferred by the VA Biomedical Laboratory Research and Development Service. The award recognizes Bank's long history of contributions to research, particularly his groundbreaking work in the emerging field of neuroimmunology—which studies interactions between the nervous and immune systems. He is considered a leading expert on the blood-brain barrier and how it functions within the body. Among his countless ground-breaking discoveries, he unearthed the mechanism of cytokine transport across the blood-brain barrier and its effect on thinking in conditions like Alzheimer's disease. He also developed the understanding that HIV-1, as a free virus, can cross the blood-brain barrier and infect the brain.
VA Puget Sound is part of the VHA Innovators Network, helping frontline employees develop innovative ideas and diffuse those ideas across the enterprise to provide superior care and the best health outcomes to our Veterans. 3D printing is just one of the many innovations we are focused on. Beth Ripley, VA Puget Sound radiologist, VA innovation specialist and VHA 3D Printing Advisory Committee hair is harnessing the power of 3D printing in health care to help radiologists better visualize patient anatomy and disease for diagnosis, surgical and treatment planning—improving health outcomes, reducing time to treatment and enhancing the patient experience.
“VA was responsible for trail-blazing innovations such as the implantable cardiac pacemaker and the nicotine patch,” Tadych said. “Now, the VA is driving ground-breaking innovations in the use of 3D printing technologies in cardiology, oncology, orthopedics, dental and other areas to deliver improved precision health care for our nation’s Veterans.”
Rick Rucker, VA Puget Sound director of Environmental Management Services (EMS) and his Customer Service Team worked with clinicians to develop a Customer Service QR code project as a feedback system so patients could communicate directly with EMS on inpatient room needs. EMS created and provided room cards with QR codes that patients and employees could use to submit requests, concerns or feedback to the team 24 hours a day, 7 days a week, 365 days a year. The practice not only improved patient satisfaction at VA Puget Sound by more than 27 percent, it earned the team national recognition. Three additional VA’s (Wisconsin, Utah and Cleveland) are currently implementing the process at their facilities, and the future looks bright for other facilities implementing the process.
Jeffrey T. Heckman, VA Puget Sound Regional Amputation Center medical director, developed FLOW3, a workflow management tool for prosthetic limb care for Veterans with limb loss. FLOW3 was so innovative and effective, it not only has been implemented across multiple care service lines at VA Puget Sound and VISN 20, it will be rolled out nationally thanks to support from undersecretaries of Health for Policy and Services, and Health for Operations and Management. Heckman showcased the impetus behind the project during a VA conference: https://youtu.be/-oazAtTm-lk.
VA Puget Sound was also one of two sites chosen as the first in the nation to adopt the VA’s new Electronic Health Record (EHR) platform. The new platform will help to ensure complete and accurate health records are shared seamlessly across VA, Department of Defense and community providers.
Along with leading positive change from within, VA Puget Sound is also very committed to collaborating with external public and private organizations to address issues such as local Veteran homelessness. Given Seattle is second only to Los Angeles in overall homelessness, this is especially important. Last year, however, VA Puget Sound’s more than 100 full-time social workers, licensed mental health counsellors, nurses, housing specialists, social service assistants and other members of its multi-disciplinary team managed nine grant-funded transitional housing programs located across four counties; addressed emergency housing with 32 contracted beds in Seattle and Forks, Washington; issued more than 2,500 HUD-VASH vouchers distributed by 12 Public Housing Authorities in 11 Washington counties; and provided outreach and support services to justice-involved Veterans via seven therapeutic Veterans Courts. This strong coordination and targeted resources seem to be making a difference. According to the All Home Count Us In 2018 report (the annual Point-In-Time count of people experiencing homelessness), King County saw a 31 percent decline in Veteran homelessness since 2017 (from 1,339 to 921), while overall homelessness remained steady.
“Every step we take to end Veteran homelessness is a step in the right direction. We know when veterans experiencing homelessness have the right opportunities, they can be successful,” said Tadych. “This reduction underscored the strong grassroot partnerships at all levels—federal, state and local—that are placing the needs of our Veterans front and center.”
VA Puget Sound also continued its long history of supporting national, regional and local recreation therapy events and programs to improve their physical, social, cognitive, emotional function and quality of life every day. Its recreational therapists, nurses and other staff took teams to the National Veterans Wheelchair Games, the National Disabled Veterans Winter Sports Clinic, the National Veterans Summer Sports Clinic and the National Veterans Golden Age Games. Regionally and locally, VA Puget Sound Spinal Cord Injury Recreation Therapy staff co-hosted Adaptive Curling Clinics at Granite Curling Club and have organized Veteran participation in the Seattle to Portland Bicycle Classic, adaptive golf clinics, Team River Run kayaking activities and many more. VA Puget Sound staff are always exploring new ways to improve quality of life for injured Veterans.
As a teaching hospital, its academic partners play an invaluable role in driving innovation and collaborative research to improve health outcomes for not only Veterans, but people worldwide. Primarily affiliated with the University of Washington Schools of Medicine and Nursing, VA Puget Sound also maintains more than 150 active associated health, graduate medical education, nursing undergraduate, graduate and research affiliations in Pacific Northwest and beyond at Seattle Pacific University, Pacific Lutheran University, Washington State University and Gonzaga University and other top universities throughout the Pacific Northwest. Last year more than 2,000 trainees walked through VA Puget Sound doors because of its innovative and progressive training opportunities. For example, VA Puget Sound selects outstanding Bachelors of Science in Nursing students to participate in its VA Learning Opportunities Residency (VALOR) program as part of their final year of nursing school. In 2018, over 75 applications were received, with 13 students selected to join the program to gain nursing experience on inpatient units at VA Puget Sound. Historically, 90 percent of its VALOR students choose to stay at VA Puget Sound after obtaining their registered nurse license.
“Whether focused on ensuring our patient rooms remain clean and infection-free, stocking our supplies or making timely appointments for follow up, the VA Puget Sound team is making positive differences in the delivery of care to our nation’s heroes,” concluded Tadych. “While we will always look for opportunities for improvement, the VA Puget Sound Team has much to be proud of!”
For more information visit www.pugetsound.va.gov.