Restructuring at Erie VA hospital a response to veterans' changing needs

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The Erie Veterans Administration Medical Center will be converting its emergency room into an urgent care center, and closing its four-bed intensive care unit in two weeks. The center is also ending its inpatient surgery service and, after Sept. 17, emergencies and more complex surgeries will be handled either at one of the community hospitals or another VA center.

But you won't hear Erie veterans complaining.

"I think generally the veterans are very pleased with the service they get there, and the people there," said Stephen Zidek, who served as a U.S. Marine officer in the 1991 Persian Gulf War and in Iraq in 2004 as part of Operation Iraqi Freedom. He is currently in the Marine reserves.

Even as the center is dropping some little-used high-end services, it is expanding services in behavioral health; it has a nationally recognized tele-health program that links the hospital to five outpatient clinics in the area; and it is sharpening its focus on home-based primary care and disease prevention.

New capital projects under way include a new ambulatory surgery center, a new behavioral health building, a freestanding community living center and a parking garage. The renovation and expansion is expected to cost $37.5 million.

"The Erie VAMC is not going away," medical director Michael D. Adelman wrote in a recent letter sent to veterans about the closure of the intensive care unit and conversion of the emergency room into an urgent care center. "There is a solid investment in this facility, as you can see by our plans to expand our campus."

The changes at the 69-bed medical center, which is not part of any systemwide initiative for the 152 VA medical centers, reflect some shifts that will happen nationally under health care reform legislation that emphasizes more outpatient and preventive care.

The Erie VA is just getting there first, motivated by the changing needs of the 21,000 or so veterans that the medical center cares for each year.

VA hospitals in Butler and Altoona are seeing similar patterns, although neither has an inpatient surgical service. "The general trend we've seen in care at VA Butler is more outpatient visits, more tele-health and more home care," spokeswoman Amanda Kurtz said.

In Altoona, "We are seeing an increase in demand for physical medicine and rehabilitation and behavioral health programs," spokeswoman Andrea Young said. "We are increasing capacity in both of those areas to serve all generations of veterans."

Spokesmen for the VA Pittsburgh Health System declined to provide information about trends in this area, although they said there are no plans for any reduction or elimination of services.

The Erie VA was never meant to handle trauma cases on a regular basis, and it has been referring more ICU patients to other hospitals so they can be treated by subspecialists. That led to an overall decline in intensive care unit patient volume and the decision to close that unit. Under VA policy, the hospital cannot continue to do inpatient surgeries without an in-house ICU.

Mr. Zidek, an assistant professor at Mercyhurst University in Erie, is adviser for the university's veterans association where he is in regular contact with returning Erie-area vets. He said the Erie VA plays an important role in helping returning veterans readjust to civilian and student life, as does the local vet center, which offers programs such as equine therapy, in which veterans work with horses, and guitar therapy.

"They offer a lot of innovative programs that get the vets decompressing and talking about things. They bend over backwards to help the guys."

Although the Erie VA will no longer offer inpatient surgery, its 22-bed acute care unit will remain open for patients undergoing outpatient procedures. Last year, all but 22 of the 3,000 surgeries at the hospital done last year were outpatient procedures.

Spokeswoman Sarah Gudgeon said the emergency room will be converted into an urgent care center open from 8 a.m. to 8 p.m. every day including holidays. As for the emergency and inpatient surgical services, she said, "We've been partnering with local community hospitals to provide our veterans with a higher level of care."

The changes will not affect any veteran's eligibility for care, and none of Erie VA's permanent staff face furloughs, although some may be reassigned, Ms. Gudgeon said.

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Steve Twedt: or 412-263-1963.


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