Update: Nurses Help Heal Walter Reed

...Twenty-eight nurses from Army hospitals as far flung as Alaska started heading to Walter Reed about a week after the Post stories were published in February.

The nurses sent to Walter Reed are working as RN case managers and are managing the clinical needs of wounded soldiers as they move from acute care to specialty care services in the medical center. As patient advocates, the case managers synchronize the provision of clinical care and facilitate the physical, spiritual, and mental healing of soldiers and their families, says Col. Patricia Horoho, RN (pictured, right), MSN, MS, deputy commander for nursing at Walter Reed...

,,,The existing outpatient system -- the medical center brigade -- that evaluated soldiers' injuries and disabilities to determine if they could return to the military or be retired with disability pay, contained case managers, but the numbers were insufficient and the protocols inconsistent, says Horoho.

There were nine social worker case managers, each of whom had 50 patients, and 11 RN case managers with a more manageable ratio of 20 patients each. But the RN case managers did not fall under nursing oversight, says Horoho.

The task force restructured the medical center brigade into a more cohesive, streamlined, standardized organization called the Warrior Transition Brigade. The 28 RNs brought to Walter Reed were added to the existing 11 RN case managers for a total of 39.

There is now a ratio of 17 patients to every case manager, well below the case management industry's standard of one manager to 30 to 35 patients, Pollock says. A lower number of patients to case managers is needed because of the acuity and complexity of the wounds soldiers have sustained, she says.

Lt. Col. Patricia Stephens-Blake, RN, was assigned as the lead case manager and reports directly to the Warrior Transition Brigade's overall commander.
A triad of care has been established within the Warrior Transition Brigade, says Horoho. This triad comprises primary care physicians, RN case managers, and military squad leaders.

In addition, a new position has been created to serve as the critical link to ensure a seamless transition from inpatient to outpatient status. This position oversees the provision of clinical care provided by inpatient and outpatient case managers and is currently filled by Betty Thomas, RN, an experienced civilian case manager from Ft. Belvoir, Horoho says.

The goal of the Warrior Transition Brigade is for all newly arrived wounded soldiers to be assigned an outpatient case manager, as well as an inpatient case manager, as soon as they arrive at the hospital.
"The concept we are moving to is to manage our warriors in transition as a team -- to manage their primary care needs and facilitate their specialty care needs so we can get them to a certain level of wellness and return them to duty or civilian life or assist them through the medical evaluation process and physical disability evaluation system," says Horoho. "We want to establish that relationship and keep managing it, working closely with soldiers' families as well," she says....