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CRDAMC recognized by MHS for innovation in health care practices

Picture of Carl R. Darnall Army Medical Center Carl R. Darnall Army Medical Center’s surgical team receives national recognition from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQUIP) for excellence in outcomes for surgical patient care in 2019. (U.S. Army photo by Mikaela Cade)

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Carl R. Darnall Army Medical Center emergency department and primary care medical teams earned recognition from the Military Health System Clinical Quality Leading Practice program for innovative practices in their respective disciplines May 5.

CRDAMC’s submissions, “Transforming Military Primary Care to a Value-based Model through QUiC Clinics” and “Stemming the hidden and Harmful Practice of Preemptive and Inappropriate ED Transfers in an Army MEDCEN,” finished in the top three of 76 entries and represent forward-thinking and innovative practice in the primary and inpatient care areas.

The teams weren’t focused on awards or accolades but on improving health care delivery for CRDAMC’s nearly 100,000 beneficiaries. The work challenged the status quo of routine practice in the emergency department and primary care clinics to improve patient care and ensure a medically ready and ready medical force.

“Some of the most forward-thinking and innovative minds in Army Medicine are right here at CRDAMC. These projects improve the mode and quality of healthcare for our patients, as well the readiness and capability of providers and health care system,” said Col. Brian Hall, deputy commander for medical services.

The Fort Hood community has been integral in the success of the effort by accepting and embracing the changes.

The medical teams, led by medical center commander Col. Richard Malish, began to tackle the problem of ensuring sick patients could get an appointment when they were ill instead of being sent to non-military entities or waiting days for an appointment.

The primary care team submission, “Transforming Military Primacy Care to a Value-based Model through QUIC Clinics,” is known simply as QUiC at the operational level. Before COVID-19, the team piloted the practice at West Killeen Medical Home; however, CRDAMC’s pandemic response required rapid adjustments leading to fast implementation at all medical homes.

Technically, QUiC challenged the current primary care model offering a variation on the delivery of care more aligned with the DHA quadruple aim.

“Rather than using a fixed appointment system, the QUiC model allows for agile healthcare delivery, specific to what a patient wants or needs. Reviewing transfers gives critical feedback to providers and leadership, leading to a more ready medical force, a better healthcare system, and a better patient experience,” said Hall.

The QUiC system has been received well in the Fort Hood community, and more than a year’s worth of data shows consistent gains in improved access, patient experience, and staff fulfillment.

On the inpatient front, the Emergency Department team evaluated the reasons beneficiaries were being transferred to the other hospitals and found that a few adjustments could make all the difference.

The work involved in their submission, “Stemming the Hidden and Harmful Practice of Preemptive and Inappropriate ED Transfers in an Army MEDCEN” at CRDAMC, may be transparent to patients impact is seen in many areas.

Making deliberate, more informed choices about patient transfers contributes to provider readiness and improves patient satisfaction. It may seem a far cry from readiness, but at the core of the provider’s competencies is the ability to engage in critical thinking. Managing more complex cases provides fertile ground for the practice of the type of thinking required on the battlefield or other austere environments.

Both practices have improved care for Active Duty service members, retirees, and their families.

“Nothing is more fulfilling than making a system or process more efficient for our patients without sacrificing quality and safety,” said Dr. Nancy Radebaugh, assistant to the deputy for quality and safety. “The two submissions our teams were recognized for demonstrate that thoughtful, data-driven, consistently implemented challenges to the status quo can improve efficiency and create a highly reliable organization.”

The CQI Leading practice program, aims to improve the quality of care within the Military Health System by identifying and implementing effective and scalable practices across the enterprise. To earn leading practice recognition, an organization must identify a measurable health service, process, or solution that improves outcomes and maximize value.

“The CRDAMC team worked hard to create new and innovative practices in primary and inpatient care. We were not afraid to assume risk to discover better ways of tackling complex issues within healthcare. We knew early on that our practices had merit. As metrics continuously improved, we packaged the ideas for scale and spread,” said Col. Richard Malish, commander of Carl R. Darnall Army Medical Center.

CRDAMC’s topics did just that by creating a culture that improved the delivery of primary care for beneficiaries and reducing the number of patient transfers from the medical center’s emergency department to civilian hospitals.

Having a leading practice for a health care entity is like having a restaurant franchise. The consumer can be assured of the same quality and experience regardless of location. Similarly, in the MHS, an identified leading practice is characterized by its ability to be effectively and consistently implemented throughout the enterprise. This franchise type effort offers military medicine beneficiaries, whether active duty or family member same quality experience and builds confidence and trust in military medicine.

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