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MAN ON A MISSION -- The VA has turned to a
Syracuse doctor
to bring some order to the irregular system of
emergency
care at their 156 medical centers.
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Man on a Mission
By James T. Mulder
Staff writer
The U.S. Department of Veterans Affairs has turned to a Syracuse doctor
to bring some order to the irregular system of emergency care at the
nation's 156 VA medical centers.
Dr. Gary Tyndall, director of the emergency department at the Syracuse
VA Medical Center, has been named national director of emergency
medicine, a new position in the VA. He will continue to run the
emergency room at the local VA hospital.
After making many improvements in quality of care, the VA in recent
years has won praise for running one of the best hospital systems in the
nation. Emergency care, however, is one area where the VA still falls
short, according to Tyndall.
Some VA hospitals have true ERs. Some operate urgent care centers
designed for patients with routine, non-life-threatening illnesses.
Equipment, staffing and design in emergency departments vary widely from
hospital to hospital.
Tyndall is leading an effort to standardize and improve emergency care
at the VA hospitals.
A veteran from Syracuse vacationing in Phoenix should be able to walk
into the Phoenix VA's emergency department and get the same level of
service he'd get at the Syracuse VA, Tyndall said.
The seeds for the ER overhaul were planted three years ago by a study
showing VA hospitals were not providing the best care for patients with
heart disease. That prompted the VA to take a look at its ERs, because
the quality of cardiac care depends largely on how well ERs are
functioning, Tyndall said.
At the same time, the VA was seeing its ERs get busier as more veterans
losing their jobs and health insurance turned to the VA for health care.
As volume increased, ERs at VA hospitals began experiencing the same
kinds of delays and backups bedeviling ERs in the private sector.
All those factors made the VA realize it needed to improve emergency
care, he said.
Tyndall, a graduate of SUNY Upstate Medical University, directed the ER
at Community General Hospital and worked in the urgent care center at
North Medical Center before joining the Syracuse VA in 2000.
The Syracuse VA's ER had been functioning as an urgent care center open
7 a.m. to 10 p.m. Tyndall was hired to re-establish an ER and to help
design the Syracuse VA's emergency department, which opened in December
2003.
Since it opened, annual ER volume at the Syracuse VA has increased 48
percent, to 12,400 patient visits.
Despite the increase, ER volume at the VA is still much lower than at
other Syracuse hospitals. Crouse Hospital's ER, for example, had more
than 55,600 patient visits last year.
The VA, however, admits about 25 percent of its ER patients, according
to Tyndall. A private hospital typically admits 7 percent of ER
patients.
The VA admits more patients because many of them have more than one
chronic illness, such as heart disease, lung disease, diabetes and high
blood pressure, he said.
Several times a week, the VA's ER gets so crowded it has to divert
patients to other local ERs. Backups occur when there aren't beds
available for patients who need to be admitted. They also occur when
nursing-home beds are unavailable in the community for patients ready to
be discharged.
The VA does not like to divert patients from its ER because many
veterans fear they will get stuck with hospital bills they cannot pay if
they go to a private hospital, Tyndall said.
It's not unusual for a veteran experiencing severe chest pains to come
from as far as Massena to the Syracuse VA for emergency care, even
though in most instances, the VA pays for emergency care in non-VA
hospitals for veterans enrolled in VA health care, according to Tyndall.
"I've told patients, 'You could have died from this,' " he said. "And
the veterans will say, 'I'd rather die than leave my family with a bill
that would take five years to pay.' "
Tyndall said the VA wants to identify the factors increasing ER volumes,
then figure out ways to ease the pressure on ERs without compromising
medical care.
James T. Mulder can be reached at 470-2245 or
jmulder@syracuse.com
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Larry Scott --
