Another example is a program developed by staff at the North Florida/South Georgia Veterans Health Care System in Gainesville, which helped reduce wait times in the hospital’s cardiology clinic. This best practice encourages physicians to review individual requests for consultations with specialists. They are asked to triage the requests to determine whether a face-to-face encounter is needed, if the request can be handled either at a local outpatient clinic or electronically, or whether the doctor needs more information before deciding what to do. In 1 year, this process reduced wait times in Gainesville’s cardiology clinic by 46%, to about 10 days.
Another Boston VA project is the development of a screening and transfer process for patients who want to be detoxified from substances to which they have become addicted. The facility’s psychosomatic medicine service team uses an algorithm for screenings and transfers that embeds available literature on the subject and a multidisciplinary consensus into an order set for electronic consultations. This results in an evidence-based, multidisciplinary, and technologic approach to the transfer process.
Federal Practitioner. Do you see DoE as a laboratory for quality of care improvement that could expand beyond the VA?
Dr. Elnahal. Absolutely. In fact, I recently coauthored, with Secretary Shulkin and Deputy Under Secretary for Health Carolyn Clancy, a commentary that provided a how-to for private sector systems to replicate our efforts. 2 In that commentary, we identified four distinct phases of diffusing best practices across health care systems: Identify promising practices, recruit champions, replicate; and establish consistency, standardize, and sustain.