In praise of VA hospitals

THE TYPICAL 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 at a hospital run by the Department of Veterans Affairs.

Surprised?

Recent news accounts about the shameful conditions at Walter Reed Army Medical Center -- a hospital unaffiliated with the Department of Veterans Affairs -- might lead you to believe that VA hospitals are a national embarrassment. That may have been true at one time. But VA hospitals have undergone a remarkable turnaround in the last decade and, on average, earn higher marks for patient safety and quality of care than most other hospitals in the United States.

For example, the VA system is well ahead of most hospitals in protecting patients from medication errors. The VA has adopted a system in which a nurse scans a barcode printed on the patient’s bracelet, indicating the name and dose of each medication the patient should be getting. The nurse then scans the pre-packaged medication to make sure it’s a match.

Another new technology -- computer physician order entry (or CPOE) -- is designed to stop doctors from prescribing the wrong medication. With CPOE, a doctor enters the prescription at a computer terminal instead of scribbling it on a pad. The computer identifies incorrect doses or a medication that conflicts with other meds the patient is taking. If the computer sounds an alarm, the physician has to override it. In Australia, Britain, New Zealand and much of Western Europe, hospitals have adopted CPOE, but most U.S. hospitals have resisted. An exception is the VA, which has installed CPOE nationwide.

The VA has also pushed ahead of most hospitals in the U.S. 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.

Dr. James Bagian, director of the National Center for Patient Safety at the Department of Veterans Affairs, points out that the VA is a leader in safety initiatives ranging from preventing injuries related to falls to fighting one of the most feared, drug-resistant hospital infections, methicillin-resistant Staphylococcus aureus. In 2002, the VA Pittsburgh Healthcare System launched a pilot program that reduced such infections a stunning 85% by enforcing meticulous hand hygiene, patient screening and precautions against spreading bacteria on gloves, clothing, wheelchairs and stethoscopes. The VA is instituting the same approach nationwide.

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 healthcare system, using information technology to track and measure the care each patient is given. The result is significantly higher compliance with best practices.

According to a 2003 study in the New England Journal of Medicine, patients in VA hospitals received better care in 12 out of 13 measures compared to Medicare-eligible patients in nongovernment hospitals. Measures included care for diabetes, depression and congestive heart failure and cancer screenings. The American Customer Service Satisfaction Index (based at the University of Michigan) shows that patients in VA hospitals are more satisfied with their care (84% vs. 74%) than patients in private-sector hospitals.

Not all 1,400 hospitals operated by the Department of Veterans Affairs are models of excellence. A recent internal VA report acknowledged that some hospitals need repair because of mold, leaky roofs or defective plumbing. Recent studies have revealed substandard conditions at three VA hospitals around the country.

But the news about Walter Reed, which has been exacerbated by attack politicians from both parties, should not obscure the truth about the standard of care for most veterans. Facility shortcomings aside, the VA delivers better care than most hospitals.