Hospital Steps Up Care for 'Warriors in Transition,' Families

By Elaine Wilson
Special to American Forces Press Service

FORT SAM HOUSTON, Texas, Aug. 24, 2007 - Since June, Brooke Army Medical Center here has implemented a series of sweeping changes designed to improve the quality of care for "warriors in transition" and their families.

The changes are driven by the Army Medical Action Plan, an Army initiative designed to eliminate bureaucratic roadblocks for warriors in transition so they can focus on recovery and have a smooth transition back to military duty or civilian life.

The first and perhaps most dramatic change is the formation of a Warrior in Transition Battalion. The battalion, which stood up June 15, replaces the former active-duty Medical Hold and reserve Medical Holdover companies. Reserve and active-duty warriors in transition now are combined in three companies under the battalion.

All battalion soldiers are in a transitional status, meaning they are wounded or ill and undergoing treatment at Brooke.

"We're all one team, so it makes sense to keep everyone under the same umbrella," said Army Master Sgt. Scott Waters, senior operations noncommissioned officer for the Warrior in Transition Battalion.

Reserve and active-duty soldiers were separated in the past to ensure familiarity with administrative processes, which differ for each component. However, the Army Medical Action Plan "gives us the resources we need to accommodate all soldiers without differentiation," Waters said. "We now have the extra help we need to successfully manage and track our warriors in transition without separation."

Since the plan was introduced, the ratio of soldier to platoon sergeant has reduced dramatically. Whereas before there were 50 soldiers to each platoon sergeant and no squad leaders at Brooke, there are now 12 soldiers per squad leader and about 30 soldiers per platoon sergeant.

But with myriad issues, ranging from severe injuries to family problems, there's "a lot to be done even with that ratio," Waters said. To ensure warriors in transition have top-notch care, the Army created the "Triad of Care" concept, which is an integral part of the battalion.

Each triad comprises a case manager, primary care manager and squad leader or platoon sergeant. Each warrior in transition is assigned to a triad, which ensures consistency and continuity of care for soldiers and their families.

"It eases the process for both the soldiers and the health care providers," said Army Lt. Col. Donna Rojas, chief of case management. "There's no confusion about who to call when there's a question or concern. The providers know exactly which squad leader to call and vice versa. And, the soldier knows exactly who to contact, as well."

Rojas provides oversight for case managers, who serve as a pivot point for the triad. Responsible for just about every aspect of a patient's health care plan, case managers ensure warriors in transition attend appointments, understand their treatment plan and are on hand to aid with everything from housing issues to family dilemmas.

Case managers meet with warriors in transition weekly and then touch base with soldiers' platoon sergeant or squad leader and primary care manager to ensure the soldiers' recovery is progressing smoothly.

"Successful treatment takes a lot of collaboration," said Army Lt. Col. Mary Burns, chief of medical management. "Case managers, PCMs and squad leaders are all looking out for the best interests of the soldiers; the key is to meet regularly and catch issues early."

Prior to the new plan, each case manager had about 35 warriors in transition assigned. But thanks to an influx of resources, 10 case managers now are assigned to each company, and the ratio has reduced to about 18 soldiers per case manager.

Primary care managers also have reorganized to provide better continuity of care. Before the Army Medical Action Plan, several PCMs unofficially were designated for warriors in transition but didn't have a space dedicated for care, and their time was divided with regular patients. Brooke Army Medical Center now officially has assigned three health care providers and a designated area of the Family Medicine Clinic to better serve wounded and ill servicemembers. In addition, the ratio of patients to PCM has changed from 1,200-to-1 down to 200-to-1. The reduction in patient load allows PCMs to spend more time with each servicemember, increasing from 20 minutes to more than an hour.

"A PCM meets with every warrior in transition within 24 hours of arrival and conducts a head-to-toe evaluation," said Dr. Sara Pastoor, chief of primary care. "We assess every aspect of the patient's health care needs, including any specialty care that may be needed, as well as preventive health care, such as tobacco cessation.

"I'm overwhelmingly impressed with and proud of everyone providing warrior in transition services at BAMC," Pastoor added. "It can be emotionally draining to provide the amount and type of health care needs involved, but it is a privilege to be exposed to the sacrifices and heroism. It's a challenging job for the PCMs, because it takes not just a thorough knowledge of medicine, but also a thorough administrative knowledge of the system."

Squad leaders and platoon sergeants, the last branch of the triad, serve as "enlisted NCO boots on the ground," Waters said. "We are there 100 percent for the soldiers and their families from the time we're notified a soldier is coming."

Squad leaders take care of everything from picking up soldiers or family members at the airport or emergency room to transporting them to medical appointments, "everything that doesn't involve medical care," Waters said.

The process starts as soon as the battalion is informed a servicemember is incoming or checking out of the hospital. "We help the soldiers get situated, and then the next morning we pick them up, introduce them to the case manager and start in-processing," said Waters, adding that U.S. Army Garrison Fort Sam Houston also provides ongoing support with transportation as well as barracks maintenance and upgrades to accommodate varying physical needs.

The NCOs work closely with case managers to ensure an open flow of communication. "We overlap in a lot of areas," Waters said. "Sometimes the soldier feels more comfortable talking with a case manager or vice versa. We keep each other in the loop to ensure all needs are being met."

Help is ongoing as squad leaders stay abreast of developments that may hinder care, such as family problems back home or a pattern of missed medical appointments. "Most warriors in transition are on some type of medication and may forget an appointment," Waters said. "They may just need a simple reminder, and we're here to do that."

As the war continues, each branch of the triad will continually seek ways to improve processes and programs to ensure warriors in transition receive the best care possible, said Army Col. Barry Sheridan, chief of warrior in transition services. "BAMC has always cared about its warriors in transition," he said. "But now, AMAP is giving us the resources we need to do what we do even better."

(Elaine Wilson works for the Fort Sam Houston Public Information Office.)
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