Cooperative program enhances patient care at Biloxi VA hospital Published Oct. 12, 2011 By 81st Medical Group Public Affairs KEESLER AIR FORCE BASE, Miss. -- For "John V.," a 67-year-old veteran and patient at the Gulf Coast Veterans Affairs Medical Center in Biloxi, a persistent infection requiring large doses of intravenous antibiotics could have meant an ambulance trip to Keesler Hospital for a special procedure. This recently changed. Usually, intravenous antibiotics and other medications are given through a simple flexible tube resting in an arm vein which allows quick and efficient administration of the medication. But patients who require long-term intravenous medications or fluids can benefit by the placement of a peripherally-inserted central catheter line inserted into a vein and advanced into the large blood vessel leading to the heart. The PICC procedure is similar to the usual IV insertion but must be performed by specially-trained health care personnel. In the past, VA patients like John had to travel to Keesler Hospital for the PICC line procedure. But in an effort to improve care for veterans and decrease costs, an Air Force nurse team from Keesler Hospital developed a process to provide PICC line placement at the local VA facility. Since John didn't want to leave the VA facility to have the PICC line inserted, Keesler nurses 1st Lt. William Moore, 81st Medical Operations Squadron, and Ramona Carroll, 81st Diagnostics and Therapeutics Squadron, along with chief surgery resident Capt. (Dr.) Chad Edwards, 81st Surgical Operations Squadron, came to him. "For the past two years, VA patients were transported to Keesler by van or ambulance to have the line placed," explained Carroll, the Keesler PICC team coordinator and instructor. "Last year, we began working on changing the sharing agreement between the Defense Department and the VA to allow Keesler nurses to go to the VA, thus providing continuity of patient care and patient safety. This enhances nursing experience and training while providing a much-needed service for the Biloxi VA Medical Center. Keesler nurses will travel to the VA weekly to place central lines for patients needing long-term antibiotic therapy or who have limited venous access. "Our nurses have worked diligently with the VA staff to improve patient care," Carroll pointed out. "This is an example of 'service before self' in action. The VA will have improved patient care since patients won't leave the facility and there won't be travel risk or delay in care. "Our second VA patient couldn't travel due to health conditions," she added. "Bringing the team to the VA where they inserted the PICC line at the bedside allowed the patient to receive the best care in a timely manner." Keesler nurses and medical residents also benefit by acquiring additional experience in PICC line placements and interacting with the VA patients and staff. In addition, it gives them the opportunity to train other nurses at both hospitals. Another benefit of the mobile team is a significant cost savings. It costs between $400 and $600 dollars to bring a VA patient to Keesler in an ambulance or van. There is also a savings in the consult services expense. "PICC placement consult was set at an allowable cost of $3,400. This will change to $250 for a consult for professional services resulting in a saving of $3,150 plus the $400-600 transportation fee," Carroll explained. Placements have been limited to difficult IV access patients or those requiring long-term antibiotics, but the Keesler team has still placed four PICC lines for the VA since the program started. Working with Carroll as part of the mobile PICC team are Capts. Reynel Garcia, 81st Inpatient Operations Squadron, and Nichole Ward, 81st MDOS; Moore and 1st Lt. Renee Shaw, 81st MDOS; and Mireya Motz, 81st MDTS. Capt. Shannon Corbin, 81st Medical Group education and training flight, was instrumental in setting up and coordinating the process with the VA. Following the recent procedure, Margaret Givens, associate director for patient care services at the VA Gulf Coast Veterans Health Care System, said, "This will enhance the care provided the veterans and your efforts are greatly appreciated. This is a great joint effort between Keesler and the VA."