Some encouraging news published today in JAMA Surgery is coming too late for my next door neighbors.
That’s because Monica, a Scottish immigrant, and her son, Paul, both are now dead. Paul, who was in his early 50s, cared for his mom in the house they rented next door to me. Like myself, Paul clearly had troubles of his own and at times was overwhelmed by his mother, who also had dementia, like my dad, albeit in a much milder form (at least at first). Plus, Monica was about 90 years old.
And even though Paul and I never got along in the beginning, when he began to lose a lot of weight I asked him what was going on. He told me he had not been feeling well but could not get into the VA right away due to long wait times.
Finally, he got in there and they discovered he had a cancerous tumor in his colon. Then they scheduled the surgery – for several weeks out.
By the time they opened Paul up, he was full of cancer. He went into Hope Creek Nursing Home and died a short time later.
His mother, her heart broken that her only child was dead so young, began to exhibit worsening dementia. Daily home care wasn’t enough. She was coaxed from her home by the police (for her own safety), never to return. After a short stint at Galesburg Cottage Hospital (where unruly elderly people are taken from the Quad-Cities to be heavily medicated and made “manageable”) she returned to Hope Creek, and died.
A sad, sad story. She had become a ward of the state after Paul died; the state got every little thing she owned to pay she and Paul’s Hope Creek bills.
The house still has not been rented, and some of her belongings are still there. It’s a big old mess. His death, her death, the fact the landlord still can’t rent the house – all examples of multiple disgraces in the Illinois Quad-Cities elder care system and the state of Illinois in general, too numerous to mention. And to anyone who rolls their eyes at that comment, I say, go right ahead. Maybe you’ll find a brain up there.
But here’s the good news
The study released today in JAMA Surgery shows how reforms put in place at a VA pilot location in Indianapolis drastically reduced delays. Using Richard L. Roudebush Veterans Affairs Medical Center as a test site, “Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows,” according to a JAMA news release. “High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-fiscal year 2013.”
Wait times were shaved from 33 days in FY2012 to 12 days by FY2014. The number of patients operated on increased from 931 in FY2012 to 1072 in FY2014.
“This study demonstrated a significant reduction in patient wait times for surgical procedures and an improvement in access in the clinical and operative settings when implementing lean processes,” the authors wrote. “The improvement gained was noted over multiple areas and seen during the implementation of new technologies. The changes in the measured outcome categories occurred early, and the differences were sustained across the entire observation period.”
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The authors reported that a “systems redesign” involving “personnel, clinicians and surgical staff to reduce systemic inefficiencies” could work throughout the VA.
In an accompanying editorial, Drs. June Ray Juliet and Seth A. Spector of Miami wrote, “Widespread negative media attention targeting patient access and wait times at the U.S. Department of Veterans Affairs institutions has prompted evidence-based reform to improve health care access and delivery.”
There goes that darned media, saving lives again.
“The stakes are high, and process, organization, and infrastructure must be reformed to ensure that health care delivery, research, education, and training proceed at the highest standard,” the editorial concludes. “This crisis provides the private and public sectors with an opportunity to consider lean transformations to expand access, reduce cost, and, most importantly, improve health outcomes and the patient experience.”