Flexible Service Environment
The ED is a complex service environment with shifting bottlenecks. To reduce wait times, EDs need flexibility in hiring and shifting responsibilities, but unfortunately federal policies are not easily adaptable for addressing such shifting demands. It routinely takes 4 or more months to hire a new physician or a nurse once a job is offered, to say nothing of the time to recruit them in the first place. If a staff member leaves, typically the position is not filled for months. The VA credentialing and hiring process needs to be thorough but significantly streamlined with the salaries reflective of equal pay for equal work. Currently, this is not the case.
To be able to confront the crowding and long wait times in the ED, the VA needs to address the root causes of crowding. First and foremost, it means expanding access to nonemergent clinics, specialists, and primary care providers. Opening clinics after hours, weekends, and on holidays would be an easy first step with significant cost saving, compared with expansion. Second, the ED needs more resources, such as more beds and additional staff, including specialists (for example, a psychiatric team in the ED). Finally, the VA needs to facilitate the movement from the ED into a hospital for patients who are admitted.
Most important, ED teams must become more nimble and flexible. Lean business practices can help keep the overall process efficient by focusing on eliminating waste or non–value-added elements. A leaner, more flexible ED can not only reduce wait times but also give veterans more value, which is exactly what they deserve.
I have worked side-by-side with the men and women who bring the VA to life, putting in long hours, with diligent attention to the highest standards and a commitment to the mission. We have saved and changed the lives of many of the patients we serve; although it is not always easy for veterans to separate issues of access to care from those of the quality of that care. Though it can be a challenge to work in a VA ED, especially now, it can also be very fulfilling.
Author disclosures
The author reports no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the author and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.