Last Friday I was privileged to spend the day at a local mil-hospital, interacting with the entire team of caregivers for the combat wounded. It was extremely informative and inspiring, and offered great networking opportunities. It was just all-around awesome!
The event--a Casualty Care (CC) "summit"--was created as an official opportunity for people in this region involved in the care and support of the combat wounded to meet, brainstorm, learn about services and treatment available, educate each other about their roles, and discuss the logistics/procedures of patient care (that last one is a huge issue). The event included everyone from surgeons and medical records specialists down through to the leader of the pet therapy volunteer team. I was there as a representative of the Armed Services YMCA and Soldiers' Angels/Valour-IT.
It was an absolutely fascinating experience. We spent the first part of the day learning about typical combat injuries, treatment issues, and the various hospital caregiver teams that contribute. For example, I learned about the diagnostic techniques and treatments for balance issues that can result from TBI, and the techniques the hospital uses to try and keep all members of a caregiving team appraised of a patient's progress in his/her many treatment regimens. We also heard from a panel of patients and family members who shared their experiences, ideas and concerns. The last half of the day was spent in brainstorming the care issues and logistical complications for a set of case studies, followed by smaller discussion groups (Clinical Care, Caseworkers, and Support Services). Finally, we met to share the issues we'd identified in the discussions.
I was so impressed with the thoroughness and dedication of the hospital staff. There were problem areas, but it was obvious they are doing absolutely everything within their power to meet the needs of both their patients and the families who stay with them. This was particularly clear in the case studies we brainstormed. They looked at everything from "How do we make sure the soldiers' home-base command is aware of his post-hospital medical needs/follow-up" to "Where do we house the mother who has accompanied her son if Fisher House is full?"
The answers to those questions were part of the singular, over-arching issue that came out of the Summit: integration. Integration between medical, military, and non-profit services is a big area of weakness. The resources out there are so vast that not everyone is aware of what is available or how to access it.
On the military/medical side, the caseworkers, caregivers, and patients' home bases need to know who their points of contact are at various points in the recovery. For example, who does the caseworker in a Naval Hospital talk to on the Army base in another state when a patient is transitioning back to limited duty at home? Or, if a patient is leaving the military, are there medical and social services closer to home than the VA facility that is two hours away?
On the non-profit side, caseworkers and caregivers need to know what is available when they run up against bureaucracy and the limitations of government medical care. This can be anything from the housing issue mentioned above to the morale-building effects of Valour-IT. And on the flip side, if there is no non-profit meeting an identified need, how does the military/medical community communicate that to the non-profits and community organizations?
Right now, the solutions to both of the integration problems are very ad hoc. The local hospital has a new database/form that tracks patient care in a general way (much less detailed that a typical "chart") so that all involved know the patient's trajectory, and caseworkers are developing contact lists as they go. But that doesn't address the larger issue of communication across organizations. The dream of the caregivers would be to have a kind of "national database" on the military Intranet that would allow them to easily identify both the points of contact and services available at military medical facilities--from the major medical centers right down to base clinics. On the non-profit and community services front, it's a similar deal.
My thoughts on the day and ideas here.