Lapcevic WA (Patient Safety Center, Tampa VA), Fitzgerald SG
(Patient Safety Center, Tampa VA), Vanderploeg RD
In April 2007, the VA issued VHA Directive 2007-013 that established policy and procedures for screening and evaluation of possible traumatic brain injury (TBI) in OEF and OIF veterans. This directive consists of a nationally developed automated identification of OEF/OIF veterans that generates a trigger for four clinical processes. Our purpose was to examine the adherence to the different steps in the clinical processes, for example keeping appointments for the follow-up TBI evaluation and any additional appointments.
A retrospective chart review of OEF/OIF veterans at one VA was recently completed. OEF/OIF Veterans who screened positive were identified by a station-level report generated from the VHA VISN Support Services Center. Medical records of TBI-screened positive veterans were downloaded from CPRS and made available in an Access database. Queries and SAS datasets were created to explore the objectives.
Of the 163 OEF/OIF veterans who screened positive for TBI at the Tampa VA, 91.4% were male with a mean age of 34 and standard deviation of 9.4 years. Seventy-five patients (46%) did not have a follow-up TBI evaluation. Potential reasons why include that 63% of the 75 did not have follow-up consults generated, and the remaining 28 patients (37%) did not make it to the appointment. Time from initial screening to TBI follow-up was 64.2 days, with standard deviation of 66.9 for the 88 patients who completed the TBI follow-up evaluation. Of those 88 individuals, 69% made it to their first scheduled appointment, with only 27 missing but ultimately receiving the care needed.
This study is the first to examine implementation of the TBI Clinical Reminder. Results suggest the TBI screening process may not be fully implemented. Almost half of veterans who screened positive did not have subsequent consults. At this time, reasons for failure to refer are unknown but could be due to programming errors within CPRS.
Findings from this study will be used to improve the health and quality of life for OEF/OIF veterans by assessing the value of the TBI Clinical Reminder Screening and subsequent evaluations and treatment.