How do you change a Veteran’s life? How do you save a Veteran’s life?
Sometimes all you need is a simple sheet of paper, as shown by the surprisingly simple Suicide Alert Red Card practice. Other times it takes complex coordination with first responders and the surrounding community through a program like the Veterans Mental Evaluation Team (VMET). From simple to complex, the winning practices — known as Gold Status Practices (GSP) – of the 2019 VHA Shark Tank Competition are all changing and saving Veteran lives.
Over 100,000 Veterans at more than 150 VA facilities across the country have already benefited from the VHA Shark Tank Competition. The innovative practices coming out of this year’s Competition will touch even more lives. During the VHA Innovation Experience, 15 innovators pitched their practices to Medical Center and Veterans Integrated Service Network (VISN) Director Sharks, who had the opportunity to bid resources and compete for the chance to implement the practices at their site. After reviewing the bids, VHA Innovation Ecosystem leadership selected 12 practices and 14 Sharks as winners of the Competition. Facilitated by Diffusion of Excellence, the GSPs listed below will proceed with implementation in the winning Sharks’ facilities.
A Whole Health Approach for Reducing Opioid Reliance and Utilization: Use of a Shared Medical Appointment for Whole Health Clinical Implementation
Gold Status Fellow: Mike Moates, Birmingham VA Medical Center
Implementing Facility: VA Boston Healthcare System
Description: This practice improves opioid safety for Veterans on chronic opioids by holding group appointments that introduce concepts of self-care and whole health, safety education and goal setting. Veterans attend group appointments to introduce self-care modalities, such as mindfulness, yoga, tai chi and opioid safety education. Of the Veterans participating in practice, 58 percent saw a reduction in their use of morphine-equivalent-daily-doses with 14 percent completely stopping the use of opoiods.
Dedicated Environmental Services Training Specialist
Gold Status Fellow: Tammy Splittstoesser, William S. Middleton Memorial Veterans Hospital
Implementing Facility: VA Northeast Ohio Healthcare System and Birmingham VA Medical Center
Description: This practice develops professional, knowledgeable technicians who are fundamental to infection control efforts and crucial to establishing an environment where safe and therapeutic health care can be provided. Ongoing training and education emphasizes and addresses the complexities of environmental care within a health care environment. It also strives to enhance a Veteran-centric employee experience by incorporating strong preceptor and Whole Health Coaching components.
Fall Boot Camp for Veterans Suffering from Parkinson's Disease
Gold Status Fellow: Rebecca Hayden, VA Central Iowa Health Care System
Implementing Facility: VA Roseburg Health Care System
Description: This practice is an eight-week program developed to decrease falls in Veterans with Parkinson’s disease. It consists of four stations that focus on improved gait through Rhythmic Auditory Stimulation and multitasking while walking; improved balance and coordination through tai chi; use of the Nintendo Wii balance obstacle course; and improved power and amplitude through boxing. Four participants meet for one hour each week for eight weeks and rotate between four stations for 15 minutes each; they are also provided pre- and post-treatment and three-month follow-up testing of their gait, dynamic balance, lower-body power and cognition. Participating Veterans were no longer at risk for falls and maintained this score for 3 months.
Geriatric Emergency Room Innovations for Veterans (GERI-VET)
Gold Status Fellow: Jill Huded, VA Northeast Ohio Healthcare System
Implementing Facility: Memphis VA Medical Center
Description: Geriatric Emergency Room Innovations for Veterans (GERI-VET) is the first comprehensive geriatric emergency department (ED) program within VHA, providing ED personnel with training in multidisciplinary geriatric evaluation and care coordination. GERI-VET provides evidence-based emergency care for aging-specific needs and ensures timely referrals to VA home and community resources.
Healthier Kidneys Through Your Kitchen
Gold Status Fellow: Rebecca Schlueter, Lexington VA Medical Center
Implementing Facilities: Salisbury – W.G. (Bill) Hefner VA Medical Center and Martinsburg VA Medical Center
Description: This practice provides a class explaining chronic kidney disease and how to slow its progression; it also includes a Healthy Teaching Kitchen demonstration. Veterans learn about kidney nutrition and are encouraged to schedule nutrition appointments.
One Consult Pathway: Whole Health and Pain Management Implementation
Gold Status Fellow: Jeffrey Kinderdietz, VA Central Iowa Health Care System
Implementing Facility: VA Eastern Kansas Health Care System
Description: It can be quite confusing to orchestrate the many non-opioid services available to reduce pain and improve function. One Consult Pathway helps providers ensure that Veterans receive the appropriate professional and self-care resources to address not only pain but their mission, aspirations and purpose in life. One Consult Pathway resulted in more Veterans receiving the help they desire and primary care providers feeling good about facilitating that help. In the 3 weeks after implementation, the number of consults increased 2000 percent with overwhelming positive feedback from providers.
Pre-operative Frailty Screening and Prehabilitation
Gold Status Fellow: Daniel Hall, Pittsburgh Healthcare System
Implementing Facility: Iowa City VA Health Care System
Description: Frail patients suffer from disproportionally high rates of adverse post-operative complications, including death — even after seemingly “minor” surgeries. By implementing a rapid point-of-care frailty assessment in outpatient surgery clinics, providers can identify high-risk patients, toimprove outcomes through a variety of interventions, such as an interdisciplinary case review; palliative care consultation to clarify frailty-specific goals of care; and “Prehabilitation” with pre-operative strength, endurance and nutritional training. Initial implementation is associated with a three-fold survival advantage among the frail with as many as 1 in 5 frail patients electing non-operative management with very low decision regret.
Suicide Alert Red Card
Gold Status Fellow: Jeanette Salvaggio, VA Northeast Ohio Healthcare System
Implementing Facility: Tuscaloosa VA Medical Center
Description: The Suicide Alert Red Card is a bold-colored silent signal that frontline personnel wave to alert coworkers for help with a suicidal caller. The Suicide Alert Red Card, which is modifiable, easily reproducible and budget friendly, is printed and laminated with contact information for several mental health staff members who assist by taking over the call. The Suicide Alert Red Card has reduced the response time to seconds as the suicidal caller reaches out in desperation. The practice has helped save 3 Veteran lives and reduced mental health response time to seconds.
Tele-Dentistry – Store and Forward Telehealth Use in Community Living Center
Gold Status Fellow: Lisa Heck, Central Texas Veterans Health Care System
Implementing Facility: Gulf Coast Veterans Health Care System
Description: This practice provides quality dental care to Veterans via Store-and-Forward Technology, avoiding the need for an in-person appointment. The practice was developed to increase access to care and provider productivity while improving efficiency using minimal resources. After implementation of this practice, the number of Veteran visits and provider productivity increased by 70 percent.
TeleRehab Wheeled Mobility Clinic to Contract Nursing Homes (CNH)
Gold Status Fellow: Jessica Hollie, Minneapolis VA Health Care System
Implementing Facility: Malcom Randall VA Medical Center and North Florida/South Georgia Veterans Health System
Description: Contract nursing home facilities that serve a large geographical area manage an increasing population of Veterans with significant complex medical needs that deserve our partnership and clinical expertise in wheeled mobility assessments and delivery. The TeleRehab Wheeled Mobility Clinic to Contract Nursing Homes (CNH) bridges the gap for rural access by eliminating travel for Veterans, increasing Veteran satisfaction, encouraging vendor partnership and decreasing VA operational costs by using a digital platform to complete telehealth visits.
Veterans Mental Evaluation Team (VMET)
Gold Status Fellow: Shannon Teague, VA Long Beach Healthcare System
Description: This practice proactively utilizes VA Police Department officers in conjunction with mental health clinicians to conduct outreach and follow-up care for cases of Veterans experiencing mental health issues or crises. VMET coordinates with community police officers to provide a VA presence for mental health crisis calls in the community. It reaches high-risk Veterans who are both connected and not connected to psychiatric care, and those experiencing mental health crises. The VMET team has responded to 823 calls and saved 70 Veteran lives.
Virtual Claims Clinic Program
Gold Status Fellow: Andrea Hill, Martinsburg VA Medical Center
Implementing Facility: Carl Vinson VA Medical Center
Description: The Virtual Claims Clinic Program has served 1,404 Veterans and provides an effective and flexible pathway to directly improve the lives of Veterans and their caregivers by using modern videoconferencing and software technology. Veterans are provided an opportunity to personally discuss their questions and concerns regarding benefits and submit claims electronically with the Veterans Benefits Administration while the Veteran is physically located at a VHA facility.
These practices will join the 47 other GSPs discovered through the VHA Shark Tank Competition in improving Veteran care. Like their predecessors, each GSP’s creator – Gold Status Fellow (GSF) – will work with counterparts from the Implementing Facility, known as an Implementing Facility Fellow (IFF). The IFF will champion the implementation of the GSP at their facility, working with the GSF and the Diffusion of Excellence Team to successfully adapt and replicate their project over six to 12 months. Everything kicks off when the GSF and IFF travel to the Diffusion of Excellence Base Camp in February 2020 at the Southeast Louisiana Veterans Health Care System.