Each year, over 2 million veterans visit our emergency departments (EDs) and urgent care centers. Emergency physicians within the Veterans Affairs (VA) health system have committed themselves to serving those who “shall have borne the battle.” Many of the staff members are Veterans themselves and are committed to the service of their brothers and sisters who were willing to make that ultimate sacrifice for our country. That continued civil service is at the core of the culture in the VA to all staff who provide care. The team of dedicated clinical and administrative professionals work tirelessly in the Department of Veterans Affairs, to fulfill President Lincoln’s promise, “to care for him who shall have borne the battle, and for his widow, and his orphan.”
The VA MISSION Act provides Veterans with the ability to receive care more easily in non-VA based community emergency departments and urgent care centers. Given the flexibility in choice for our Veterans to seek care anywhere, even outside the VA system, why choose the VA? In short, VA emergency departments and urgent care centers are geared to our Veteran population and their needs. Over 47 percent of our two million visits are Veterans aged 65 years or older. Over 41 percent of all visits are for patients with comorbid mental health conditions. The VA does not seek to be the premier pediatric or trauma emergency department in the country—that is done very well at community emergency departments. However, we are focused on being the premier geriatric and mental health emergency departments for Veterans. To date, 34 VA emergency departments have received ACEP’s Geriatric Emergency Department Accreditation, making VA the largest integrated health care system with specialized geriatric emergency care. In the VA, we recognize the differences in experience that make our Veterans unique and lead to different care needs, and we seek to cater to them with our health care and meet these special needs. We link behavioral health with primary care, provide whole health services, and are utilizing our unique position as a federal health care system to grow tele-emergency care and meet our Veterans wherever they are.
This focused expertise found within the VA system has translated to amazing outcomes for our Veterans. A February 2022 study from Stanford University found that Veterans taken by ambulance to VA emergency departments had a significantly lower mortality rate than those treated at non-VA emergency departments. Veterans can get care in any ED in the country, as with any other visit for acute, unscheduled care. We want our Veterans to seek care appropriately at the nearest community emergency department or urgent care. We know they are in good hands with our community partners. But it is the VA emergency departments and urgent cares that are designed for them. For a Veteran, walking into a VA medical center, outpatient clinic, or into one of emergency departments and urgent care centers should feel like coming home. The culture provided by VA staff for our patients will have a familiarity that is hard to describe without walking a mile in the shoes of a Veteran.
How Non-VA Emergency Physicians Can Help
We want to reconnect Veterans who are receiving care in the community back to the VA system. We want our Veterans to receive care that is made for them, from those that know their history and have the resources and ability to coordinate their ongoing care needs. You can help us educate Veterans on the services offered by VA. We have created brochures outlining what we offer and are making it easier for the community and our Veteran population to understand when and where to seek care. We are asking you to help us in identifying Veterans in your emergency department and getting them these brochures and resources. Together we can educate Veterans on when and how to seek care. It is our goal to provide the right care, at the right place, at the right time for Veterans, and we need your help to see this goal through. By referring Veterans back to the VA system, we can help reduce the risk of medication misadventure because we have their complete medication and past medical history on file. We can more easily set them up for appropriate follow-up and continuity care as an integrated health system. And we may have a greater potential of being able to avoid admissions for Veterans since we are able to coordinate care and have access to hospital-at-home-type resources. This would also reduce the burden on community EDs and overall make it easier for the community ED provider to deliver the right care for the Veteran.
Dr. D‘Amico serves as clinical consultant for emergency medicine for the U.S. Department of Veterans Affairs. He is also the chief of emergency medicine at the Veteran’s Affairs Health System of Pittsburgh and an assistant professor at the University of Pittsburgh School of Medicine.
Dr. Geiger serves as executive officer for emergency medicine for the U.S. Department of Veterans Affairs. He is a United States Marine Corps veteran.
Dr. Jetter serves as program manager for emergency medicine at the U.S. Department of Veterans Affairs. He is also a medical student at the University of Florida College of Medicine in Gainesville, Fla
Dr. Kessler serves as executive director of emergency medicine for the U.S. Department of Veterans Affairs. He is also the host of the C20 Vodcast and a professor of medicine at the Duke University School of Medicine in Durham, N.C.
Dr. Patel serves as the acting deputy executive director of emergency medicine for the U.S. Department of Veterans Affairs. He is also the chief of emergency medicine at the VA Greater Los Angeles Healthcare System.
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