Over the past decade, there has been a pivotal paradigm shift in the delivery of quality healthcare services through the utilization of telehealth, most notably since the COVID-19 global pandemic. At the forefront of this change is the Department of Veterans Affairs (VA), which has implemented and cultivated the innovation of home telehealth (HT) remote patient monitoring to improve access to care, especially for the rural and high-risk patients population since 2003. These telephonic and video-capable services offer close surveillance of patient-reported data by HT nurse care coordinators and medical support staff working closely with Patient Alignment Care Teams (PACT), specialty clinics, PharmD clinics and ancillary services to address holistic care needs.
As a result of a substantial winter and ice storm in February 2021, the state of Texas suffered momentous electrical, water and supply chain shortages that directly affected the health and welfare of all its citizens and in turn led to interruptions of physical, emotional and local resources. This unforeseeable storm led to devastating electrical outages that caused loss of power throughout South Texas along with limited access to transportation and road closures. Subsequently, grave threats that could adversely affect veteran safety and access to emergent medical care were identified, prompting an immediate plan of prevention to mitigate potential harm or even death. The South Texas VA Medical Center’s (STXVAMC) home telehealth team recognized the importance of reducing interruptions in care for vulnerable patients, such as those of dialysis or oxygen-dependent patients, through techniques such as weather forecasting and preliminary inclement weather preparation. In this article, we will show how a shared governance case management structure allows the ability to improve safety and access to care in the vulnerable veteran high-risk patient population during unforeseen natural disasters.
The STXVAMC home telehealth department executed an emergency management plan that consisted of contacting assigned veterans to assess needs, triaging potential emergencies and routing appropriate emergency care and/or social work resources. This was achieved through strategic planning using clear and concise communication, routine updates of patient demographic spreadsheets stored in centralized locations, pre-incident daily safety weather briefs, pre-incident vulnerable patient checklist, hourly staff recall meeting updates and creating a consolidated emergency resource list. An after-action-review (AAR) was performed to analyze the overall response to the emergency plan. This information was then used to identify areas of improvement and sustainment including internal and external communication and standardized documentation.
The overall goal of the AAR was aimed at evaluating the STXVAMC HT department emergency management response through a shared governance structure by front-line case managers. The initial approach consisted of a reflection of opportunities used to safely and effectively activate the Home Telehealth Emergency Operations Plan for identification of emergent care/needs in accordance with regulation. The front-line case managers identified, connected and aided the high-risk patient population to services and resources desperately and urgently needed during times of uncertainty and in austere conditions. This emergency preparedness allowed for enhanced communication among home telehealth staff and between other hospital departments, which led to presenting this emergency initiative to local and VISN level leadership, prompting a collaboration of planning and execution of emergency practice drills within VISN telehealth programs, thus improving overall emergency management readiness for any future inclement weather situations across the spectrum.
Overall outcomes of the execution of this emergency response plan included eliminating barriers and improving access to care during emergency operations through a holistic patient care assessment approach, initiating emergency care/medical services and referrals for community care services and amplifying team dynamics through implementing strategies for future situational crisis. As a result, an improved emergency plan was adopted, including a standardized emergency preparedness documentation and an emergency management note designed to capture medical essential needs such as oxygen therapy, generators, continuous positive airway pressure machines, renal dialysis transport, electrical stability, local shelter, food and water support.
, MBA, MSN, RN, CCM, has been a registered nurse for 30 years. She obtained her bachelor’s degree with a major in nursing from The Pennsylvania State University and was commissioned as an Air Force officer in the Nurse Corp. Later she obtained a dual master’s degree, MBA and MSN, from Carlow University in Pittsburgh.
During her time as active duty, Jill worked in a variety of healthcare settings to include: inpatient care, outpatient care, emergency room, labor and delivery and peri/post operative care.
Currently she works within the South Texas Healthcare Administration in the role of home telehealth care coordinator. In this position she uses the advances in telehealth to bring healthcare to vulnerable veterans with chronic care conditions.
In her time away from work, Jill enjoys Pure Barre exercise classes and spending time with her two Bernedoodles, Flux and Texas Ranger.
, MSN, RN, is an experienced nurse with over 31 years of diverse nursing experience that includes complex disease case management. Currently, Lori is a telehealth case manager at the South Texas Veterans Hospital and is a leader among her colleagues through hospitalwide committees. She facilitates and participates in several nursing excellence committees and currently is a Nursing Excellence Ambassador and the chair for the Center of Nursing Excellence. Ms. Bruce has been a poster presenter at national conferences: CMSA and the ANCC Magnet/Pathway to Excellence and a longstanding member of the Case management Society of America and a leader in the Alamo Chapter CMSA serving many board positions and currently as the CMSA awards committee co-chair.
, BSN, RN, nurse case manager/telehealth, South Texas Veterans Healthcare System, completed her undergraduate degree at the UTHSC at San Antonio TX in 1994. Her carrier has spanned diverse nursing positions in ICU, cath lab, interventional radiology and ER. Most recently, Maria moved from bedside nursing into telehealth case management at South Texas Veterans Healthcare System, where she currently thrives.
, MSN, RN, AMB-BC, is a member of the Alamo Chapter of CMSA, serves on the CMSA Military/VA Committee and served as a panelist at the 2023 CMSA Conference. She works at South Texas VA as the assistant nurse manager in home telehealth. In her 15-year nursing career, she has worked in numerous clinical and administrative roles in the areas of medical surgical nursing, ambulatory care, patient/staff education, home telehealth and management. Ms. Carter has ambulatory care certification through the ANCC. She is currently pursuing her doctor of nursing practice through Walden University. She is a graduate of VA Leadership Programs and was a nominee for the Secretary of VA’s Nursing Award. Her contributions have gone to the national level and been adopted by other VA sites. She is committed to excellent care of veterans.
, MSN, BHSc, RN, U.S. Army retired, home telehealth care coordinator, South Texas VA Healthcare System, has over 19 years of nursing experience that encompasses veterans care coordination and disease management, ICU, med/surg, and detainee healthcare. She served as the senior enlisted program manager for the AMEDD Center and School Army Nurse Case Managers and Wounded Warriors Leadership course from 2013-2015. She is currently a home telehealth nurse master preceptor, Office of Connected Care disease management program reviewer and emergency management and preparedness committee member. Shimeca is the 2022 recipient of the prestigious Secretary of VA Award for Excellence in Nursing for her integral role in improving transitions of care among heart failure patients.
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