scholarly journals Procedural Volume Within Military Treatment Facilities—Implications for a Ready Medical Force

2020 ◽  
Vol 185 (7-8) ◽  
pp. e977-e981
Author(s):  
Brandon M Carius ◽  
Michael D April ◽  
Steve G Schauer
Keyword(s):  
Retrospective Analysis ◽  
Central Venous Access ◽  
Military Force ◽  
Central Venous ◽  
Data Set ◽  
Military Health ◽  
Procedural Volume ◽  
Treatment Facilities ◽  
The Military ◽  
Military Treatment Facilities

Abstract Introduction Consistent procedural volume is important for emergency physicians (EPs) to maintain opportunities for critical lifesaving skills. While non-EP literature demonstrates improved patient outcomes with higher volumes, few studies examine the optimal number of repetitions needed to maintain procedural competency in EP populations. The largely young, healthy active duty population that constitutes the majority of patients in military treatment facilities (MTFs) decreases the likelihood to utilize emergent procedures. Despite this likelihood, EPs are expected to maintain proficiency and readiness to perform critical procedures in deployed settings. Materials and Methods A retrospective analysis of de-identified data obtained through the Military Health System Mart was performed for procedural codes involving surgical airway, central venous access, and intubation. Data were sought for 2014–2016 calendar years from seven Army hospitals under the Southwest Region Medical Command. Procedural numbers were obtained for both overall volume and those performed per 1,000 encounters. Additionally, we analyzed for volume differences with the highest volume MTF (Brooke Army Medical Center [BAMC]) removed from the data set. Results A total of 1,450 procedures were performed among the MTFs analyzed, including 973 intubations, 473 central venous catheter placements, and 4 surgical airways. MTFs averaged 69.5 intubations and 38.8 venous catheters placed each year, but decreased to 28.1 intubations and 13.0 venous catheters placed annually when BAMC was removed from the data set (a 59.6 and 61.6% decrease, respectively). Monthly averages of 40.5 intubations and 19.7 central venous catheterizations per month among all included MTFs decreased to 14.0 and 6.5 when BAMC was removed. All surgical airways were performed at BAMC. Procedural frequency per 1,000 encounters was highest at BAMC, although ordinal differences were noted in the remaining six MTFs compared with overall procedural volumes. Conclusions This retrospective analysis demonstrates a significant variation in procedural volumes across MTFs, illustrating disproportionate opportunities for procedural skill maintenance among Army EPs. Low procedural volume threatens the maintenance of critical EP skills. These numbers could also suggest low skills for other providers (such as physician assistants), further illustrating decreased skill readiness throughout the force. Further research is needed to examine procedural volumes per individual EP, as well as those performed by other providers to evaluate for overall procedural readiness across the military force.

scholarly journals Volume as an Indicator for Outcomes for Severe Maternal Morbidity in the Military Health System

2021 ◽  
Author(s):  
Aimee Hunter ◽  
Amanda Banaag ◽  
Monica A Lutgendorf ◽  
Col Barton Staat ◽  
Tracey P Koehlmoos
Keyword(s):  
Health System ◽  
Maternal Morbidity ◽  
Healthcare Systems ◽  
Severe Maternal Morbidity ◽  
Military Health System ◽  
Case Volume ◽  
Military Health ◽  
Treatment Facilities ◽  
The Military ◽  
Military Treatment Facilities

ABSTRACT Background Maternal obstetric morbidity is a growing concern in the USA, where rates of maternal morbidity exceed Europe and most developed countries. Prior studies have found that obstetric case volume affects maternal morbidity, with low-volume facilities having higher rates of morbidity. However, these studies were done in civilian healthcare systems that are different from the Military Health System (MHS). This study evaluates whether obstetric case volume impacts severe maternal morbidity (SMM) in military hospitals located in the continental United States. Methods This cross-sectional study included all military treatment facilities (MTFs) (n = 35) that performed obstetric deliveries (n = 102,959) from October 2015 to September 2018. Data were collected from the MHS Data Repository and identified all deliveries for the study time period. Severe maternal morbidity was defined by the Centers for Disease Control. The 30-day readmission rates were also included in analysis. Military treatment facilities were separated into volume quartiles for analysis. Univariate logistic regressions were performed to determine the impact of MTF delivery volume on the probability of SMM and 30-day maternal readmissions. Results The results for all regression models indicate that the MTF delivery volume had no significant impact on the probability of SMM. With regard to 30-day maternal readmissions, using the upper middle quartile as the comparison group due to the largest number of deliveries, MTFs in the lower middle quartile and in the highest quartile had a statistically significant higher likelihood of 30-day maternal readmissions. Conclusion This study shows no difference in SMM rates in the MHS based on obstetric case volume. This is consistent with previous studies showing differences in MHS patient outcomes compared to civilian healthcare systems. The MHS is unique in that it provides families with universal healthcare coverage and access and provides care for approximately 40,000 deliveries annually. There may be unique lessons on volume and outcomes in the MHS that can be shared with healthcare planners and decision makers to improve care in the civilian setting.

scholarly journals “We Want to Build a Network”: Professional Experiences of Case Managers Working With Military Families

2019 ◽  
Vol 6 ◽  
pp. 2333794X1986978 ◽  
Author(s):  
Robyn Englert ◽  
Renee Dell’Acqua ◽  
Shannon Fitzmaurice ◽  
Abigail Marter Yablonsky
Keyword(s):  
Military Families ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Well Being ◽  
Case Managers ◽  
Military Health ◽  
Professional Experiences ◽  
Treatment Facilities ◽  
The Military

Optimizing case management (CM) services increases service member readiness at home and abroad. However, little research has been conducted on the experiences of case managers providing services to military families within the Military Health System. Semistructured qualitative interviews were conducted to explore the professional experiences of case managers to identify factors that may affect care to military families. A total of 53 case managers from military medical treatment facilities (MTFs) varying in size, location, and branch of service were interviewed by telephone to explore their perspectives. Qualitative content analysis was performed. Case managers serve a variety of functions, but specific roles vary between MTFs. Factors that affect CM services for military families were identified: (1) need for pediatric specialization, (2) heavy workload, (3) appropriate staff, (4) patient handoffs, and (5) the role of CM. Recommendations for improving CM services to facilitate the well-being of military families are discussed.

scholarly journals Leading the Military Health System Transformation: From Military Treatment Facility to Market Construct

2020 ◽  
Vol 185 (Supplement_3) ◽  
pp. 3-11
Author(s):  
John J Melton ◽  
Jeffrey W Quick
Keyword(s):  
Organizational Performance ◽  
Medical Center ◽  
Health Agency ◽  
System Transformation ◽  
Multiple Stakeholders ◽  
Military Health ◽  
Effective Relationships ◽  
Treatment Facilities ◽  
Military Treatment Facility ◽  
The Military

ABSTRACT The transition of authority to manage and administer all DoD Medical Treatment Facilities from the Military Department Services to the Defense Health Agency is an extremely complex challenge involving multiple stakeholders and systems in an effort to achieve greater force readiness while reducing cost. Womack Army Medical Center at Fort Bragg served as the U.S. Army’s sole prototype for the initial phase of the transition of authority. Starting with a foundational shift to an organizational outward mindset was essential in building effective relationships to exercise Mission Command at echelon to manage risks to mission during this period of uncertainty and ambiguity. This shift in mindset set the conditions for mobilizing Army Doctrine, elicited, and invited collaborative behaviors, and resulted in the improved organizational performance accomplished with velocity to successfully lead the transformation to Defense Health Agency.

A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: A low risk central venous access approach in the neonatal intensive care unit

2020 ◽  
pp. 112972982096929
Author(s):  
Matthew Ostroff ◽  
Adel Zauk ◽  
Sara Chowdhury ◽  
Nancy Moureau ◽  
Carly Mobley
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Retrospective Analysis ◽  
Neonatal Intensive Care ◽  
Femoral Vein ◽  
Central Venous Access ◽  
Venous Access ◽  
Right Atrial ◽  
Central Venous

Objective: The purpose of this retrospective analysis was to evaluate the clinical efficacy and safety of ultrasound (US)-guided, subcutaneously tunneled, femoral inserted central catheters (ST-FICCs) in the neonatal intensive care unit (NICU). Methods: Following clinical success with ST-FICCs in adults, we expanded this practice to the neonatal population. In an 18-month retrospective cohort analysis (2018–2020) of 82 neonates, we evaluated the clinical outcome for procedural success, completion of therapy, and incidence of early and late complications for insertion of US-guided ST-FICCs in the NICU. Results: Placement of ST-FICCs were successful in 100% of neonates ( n = 82/82) with 94% to the right ( n = 77/82) and 6% to the left common femoral veins ( n = 5/82). Gestational age ranged 23-39 weeks with median age of 29 weeks. Birthweight ranged from 450 g to >2000 g. Weight at insertion ranged 570 to 3345 g and day of life 1 to 137, with median at day 5. Ultrasound guided femoral vein puncture was recorded on 74 patients, first attempt 63/74 (85%), second attempt 8/74 (11%) and third attempt 3/74 (4%). Catheter french used: 1.9Fr ( n = 80/82), 2.6Fr ( n = 1/82), and 3-Fr ( n = 1/82). Catheter lengths were 8 to 20 cm, average 12cm. Catheter termination confirmed with posterior/anterior and lateral abdominal radiographs with inferior vena cava (IVC) ( n = 33/82), IVC/right atrial junction ( n = 31/82), or right atrium ( n = 18/82). Atrial placements were retracted; no cases of malposition to the lumbar/renal/hepatic veins ( n = 0/82). 1528 catheter days ranging 5 to 72 days (average 18). No insertion-related or post-insertion complications. All patients completed prescribed therapy with one catheter. Conclusion: Bedside placement of an ST-FICC is a safe route for central venous access in the NICU, preserving upper extremity vasculature, eliminates risks associated with sedation, fluoroscopy, tunneled and non-tunneled supra-diaphragmatic central venous insertion.

scholarly journals Clinical Readiness Program: Refocusing the Military Health System

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 32-39
Author(s):  
Danielle B Holt ◽  
Matthew T Hueman ◽  
Jonathan Jaffin ◽  
Michael Sanchez ◽  
Mark A Hamilton ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Health System ◽  
Care Delivery ◽  
Military Health System ◽  
Military Health ◽  
Orthopedic Surgeons ◽  
Combat Casualty ◽  
General Surgeons ◽  
Treatment Facilities ◽  
The Military

ABSTRACT Introduction The Military Health System serves to globally provide health services and trained medical forces. Military providers possess variable levels of deployment preparedness. The aim of the Clinical Readiness Program is to develop and assess the knowledge, skills, and abilities (KSAs) needed for combat casualty care. Methods The Clinical Readiness Program developed a KSA metric for general and orthopedic surgery. The KSA methodology underwent a proof of concept in six medical treatment facilities. Results The KSA metric feasibly quantifies the combat relevance of surgical practice. Orthopedic surgeons are more likely than general surgeons to meet the threshold. Medical treatment facilities do not provide enough demand for general surgery services to achieve readiness. Conclusion The Clinical Readiness Program identifies imbalances between the health care delivery and readiness missions. To close the readiness gap, the Military Health System needs to recapture high KSA value procedures, expand access to care, and/or partner with civilian institutions.

scholarly journals Identifying Best Practices in Pharmacy Experience: An Analysis of Military Treatment Facilities With the Highest Pharmacy Patient Experience Scores

2021 ◽  
Author(s):  
Chantell Frazier ◽  
Kimberley Marshall-Aiyelawo ◽  
Melissa Gliner ◽  
Craig Holden ◽  
Tara Fowler ◽  
...  
Keyword(s):  
Best Practices ◽  
Patient Care ◽  
Patient Experience ◽  
Hospital Admissions ◽  
Improve Patient Care ◽  
Future Research ◽  
Clinical Environment ◽  
Military Health ◽  
Treatment Facilities ◽  
Military Treatment Facilities

ABSTRACT Introduction Pharmacy patient experience within military treatment facilities (MTFs) is a significant indicator of healthcare quality, as hospital admissions correlate with medication use (Budnitz et al., 2006) and pharmacists have a unique opportunity to influence patients’ health (Dalton & Byrne, 2017). To improve patient care across the military health system (MHS), we investigated best practices within MTF pharmacies with the highest patient experience scores. Materials and Methods Researchers performed semi-structured telephone interviews with pharmacists, pharmacy technicians, and patient experience officers from three of the highest ranked MTF pharmacies according to outpatient satisfaction survey results to glean “best practice” approaches to patient care. Researchers utilized the Gioia approach as a guiding theory for qualitative analysis of the interview data, and the study was excluded from a requirement to obtain institutional review board approval due to the number of respondents in accordance with the Paperwork Reduction Act of 1980 guidelines. Results Interview participants from highly rated pharmacies emphasized the importance of communication among and between staff and patients, staff engagement and morale, and supportive leadership at their facilities for creating a positive patient experience and clinical environment. Conclusion These findings provide valuable insights to improve public health in military-connected populations through improved patient care practices in pharmacies across the MHS. Initiatives aimed at improving health care for pharmacy patients should prioritize improved communication and structural support for team members to create patient-friendly environments, which enables pharmacists and technicians to connect with patients and positively impact health outcomes. Limitations include lack of comparison data for lower performing pharmacies; future research will explore practices at lower ranking pharmacies to provide insights into communication practices, environments, and staff relationships impacting patient experience scores as well as the role patient demographics (e.g., retirees vs. active duty) and characteristics including facility size play in potential improvements.

scholarly journals The Military Treatment Facility COVID-19 Response in an Isolated Rural Environment: Challenges and Lessons Learned

2021 ◽  
Vol 186 (Supplement_2) ◽  
pp. 44-49
Author(s):  
Breslin T Gillis ◽  
William O Murray ◽  
William J Brown
Keyword(s):  
Tertiary Care ◽  
Lessons Learned ◽  
Rural Environment ◽  
Response Force ◽  
Current Crisis ◽  
Foreign Countries ◽  
The Usa ◽  
Treatment Facilities ◽  
The Military ◽  
Military Treatment Facilities

ABSTRACT The coronavirus disease-2019 (COVID-19) pandemic remains an extraordinary event that continues to strain healthcare systems worldwide. Unlike the military treatment facilities (MTFs) in the USA, which have ready access to tertiary care facilities, those MTFs in foreign countries confront a host of challenges in meeting mission requirements. In this article, we discuss the MTFs’ COVID-19 response in the rural environment of Bavaria, Germany. Relevant factors including regional and clinic response, force health protection, and contingency planning, which influenced the MTFs response, are identified. These factors are further analyzed from a “lessons learned” perspective, and recommendations to shape the future response to a pandemic are provided. This current crisis portends a future where pandemics may remain an omnipresent threat.

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