Military Might
Today's VA hospitals are models of top-notch care
Three summers ago, Augustin Martinez's skin was yellow. He was in pain. And physicians at Kaiser Permanente, his usual source of care, were baffled. The frustrated Martinez, a retired Lockheed Martin engineer in San Jose, Calif., asked his brother, a New York physician, for advice. After consulting colleagues, his brother advised him to go to the Department of Veterans Affairs hospital in nearby Palo Alto. Martinez, a former Navy petty officer 2nd class, was entitled to VA care (eligibility depends on several factors, including date and length of military service, injury, and income). But his brother's recommendation took him by surprise. Better care at a VA hospital? But he went--and was quickly diagnosed with pancreatic cancer by Sherry Wren, chief of general surgery, who operated on him within days. He has relied on VA hospitals and clinics ever since. "They run a good ship," says Martinez, now age 72.
That they do, say healthcare experts. Routinely criticized for decades for indifferent care, attacked by Oliver Stone in Born on the Fourth of July, the VA health system has performed major surgery on itself. The care provided to 5.2 million veterans by the nation's largest healthcare system has improved so much that often it is the best around. And in the new VA, patient safety is a particular priority. Before making the first incision, for example, surgeons conduct a five-step audit to be sure they don't cut into the wrong body part or person. Doctors and nurses are unusually conscientious about hand hygiene, to reduce infections caused by carrying germs from one patient to another.
Technology helps, as would be expected. Martinez is particularly impressed by the computerization of patient records. When he visits, his doctors and nurses instantly call up his medical records, including test results (his cholesterol is high and he suffers from asthma), CT scans, and medications via laptop, which has become as ubiquitous a tool at VA facilities as a stethoscope.
Paper delay. But computerized records are more than a convenience. If all patient information could be reviewed on a computer screen and updated with each new test and observation, studies suggest that many of the medical errors that kill hospital patients would be prevented. Keeping everything on paper has been shown to delay care, force 1 in every 5 lab tests to be repeated, and cause unnecessary hospitalizations. But switching to computerized records can cost millions of dollars at a single hospital, so relatively few medical centers outside the VA have changed over.
"The information is right at your fingertips, right at the bedside, right when you're making decisions," Wren says. Besides giving her a quick snapshot of a patient's progress, the system automatically displays the latest and best studies and guidelines for that patient's condition. The screen also prompts her about preventive measures. If she calls up the record of a diabetic patient, for example, she is reminded to perform or schedule foot and eye exams, which diabetics must have regularly to prevent amputation or blindness.
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