What the VA Does Right
BY BETSY McCAUGHEY
The average hospital patient is given the wrong medication or the wrong dose at least once a day, according to the Institute of Medicine, a research organization that advises Congress.
The good news is that these mistakes are less likely to happen in a hospital run by the Department of Veterans Affairs. Surprised?
Recent news accounts might lead you to believe that VA hospitals are a national embarrassment. That may have been true at one time. Not any more. VA hospitals have undergone a remarkable turnaround in the last decade. On average, they earn higher marks for patient safety and quality of care than most other hospitals in America.
The shameful conditions of Walter Reed, which is an Army hospital unaffiliated with the Department of Veterans Affairs, have misled the public. The situation has been exacerbated by attacks from politicians in both parties who are excoriating the VA without knowing the facts.
The VA system is well ahead of most hospitals in protecting patients from medication errors. How? By adopting bar coding. The nurse scans the barcode printed on the patient's bracelet, indicating the name and dose of each medication the patient should be getting. Then the nurse scans the barcode on the pre-packaged medication to make sure it's a match.
Another new technology — computer physician order entry — is designed to stop doctors from prescribing the wrong medication. With CPOE, the doctor enters the prescription at a computer terminal instead of scribbling it on a pad. The computer is programmed to identify incorrect doses or a medication that conflicts with other meds the patient is already taking. If the computer sounds an alarm, the physician has to override it. In Australia, Great Britain, New Zealand, and much of Western Europe, hospitals have already adopted CPOE, but most American hospitals have resisted it. The exception is the VA hospital system, which has installed CPOE nationwide.
The VA has also pushed ahead of most hospitals in America by investing in electronic medical records, allowing a patient's medical history to be accessed in a few seconds. The VA database is a resource for medical researchers and the envy of the private sector.
The director of the National Center for Patient Safety at the Department of Veterans Affairs, Dr. James Bagian, points out that the VA is ahead on a wide range of other safety initiatives. One is preventing injuries related to falls, by providing fragile patients with easy to wear padded hip protectors. Mr. Bagian is zealous about patient safety. He described the difficulties of getting older patients in and out of hip-protectors and the importance of preventing life-altering fractures.
VA hospitals are also ahead of the industry in fighting one of the most feared, drug-resistant hospital infections, methicillin-resistant Staphylococcus aureus or MRSA. In 2002, the VA Pittsburgh Healthcare System launched a pilot program that reduced MRSA infections by a stunning 85%. How? By enforcing meticulous hand hygiene, screening to identify patients carrying the bacteria, and taking precautions to prevent the bacteria from spreading to other patients via gloves, wheel chairs, stethoscopes, nurses uniforms, and doctors' lab coats. Now the VA is instituting the same approach nationwide, including providing rapid MRSA testing equipment.
Patients in VA hospitals are also more likely to receive optimal care than patients in other hospitals. In the late 1990s, the VA re-engineered its health care system using information technology to track and measure the care each patient was given. The result is significantly higher compliance with best practices.
According to a study in the May 2003 edition of the New England Journal of Medicine, patients in VA hospitals, compared to Medicare-eligible patients in nongovernment hospitals, received better care in 12 out of 13 measures. Measures included care for diabetes, depression, congestive heart failure, and preventive cancer screenings. A RAND study of 12 VA hospitals published in 2004 in the Annals of Internal Medicine showed similar results, though it also found a higher mortality for coronary bypass procedures in those hospitals.
Not all 1,400 hospitals operated by the Department of Veterans Affairs are models of excellence. A recent internal VA report acknowledges that some hospitals are in need of repair, with mold, leaky roofs, and defective plumbing. Also, the department's inspector general recently cited the James A. Haley Medical Center in Tampa, Fla., for serious shortcomings, and another report cited substandard conditions at the Nashville and Murfreesboro, S.C., facilities.
Physical shortcomings aside, the VA delivers better care than most hospitals. It shouldn't be a surprise that the American Customer Service Satisfaction Index, based at the University of Michigan, shows that patients in VA hospitals are more satisfied with their care on average — 84% to 74% — than patients in private sector hospitals.
Ms. McCaughey, the former lieutenant governor of New York State, is the founder and chairman of the Committee to Reduce Infection Deaths, www.hospitalinfection.org , a nonprofit campaign to improve hospital hygiene and procedures.
