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From Ship to Shore – Navy Medicine Gets Real, and Better, About Patient Movement

12 October 2023

From ANDRÉ SOBOCINSKI

Even under ideal conditions, the urgent or emergent movement of ill or injured Sailors and Marines from ship to shore can be a complex operation. These transfers can occur at night and in poor weather conditions, adding an extra layer of challenges. Furthermore, the unplanned nature of these medical movements can impact the degree of operational
Even under ideal conditions, the urgent or emergent movement of ill or injured Sailors and Marines from ship to shore can be a complex operation. These transfers can occur at night and in poor weather conditions, adding an extra layer of challenges. Furthermore, the unplanned nature of these medical movements can impact the degree of operational risk management associated with planned movement missions.

These factors can lead to increased safety risks, accountability issues, information gaps, and incomplete or difficult communications with the originating command. Additionally, once a Service Member is received by a Military Treatment Facility (MTF), privacy concerns, communication constraints, complicated command structures, and simple geography or communication restrictions can be contributing factors to a lack of parent command situational awareness.

In 2019, the Pacific Fleet surgeon requested Navy Medicine support to apply Get Real, Get Better principals to improve Patient Movement safety, communications, and outcomes, while protecting privacy, when Service Members are moved for medical reasons from at-sea units (to include units in port) to any shore-based civilian or MTF across the enterprise.

“This project had been piloted down in Third Fleet with Naval Medical Center (NMC) San Diego,” explained Capt. Joon Yun, Commander, Task Force (CTF)-80-Surgeon, Fleet Forces Command, who has played a pivotal role as member of the PM action team along with representatives from the Bureau of Medicine and Surgery (BUMED), Tripler Army Medical Center, Naval Medical Center (NMC) Portsmouth, NMC San Diego, Naval Hospital (NH) Camp Pendleton and other Subject Matter Experts (SMEs). Collectively, this action team identified a multitude of improvements to the ship-to-shore PM process and then worked with NMC San Diego to initiate a pilot program to test and implement improvements in pre-coordination. The impact was immediate.

From November 2019 to February 2020, Third Fleet completed 25 successful ship-to-shore medical transfers to NMC San Diego using a pre-coordination system.

“If a member is concerned if a skin lesion could be melanoma, we can coordinate the care, make sure they have a dermatology appointment or the dermatologist on call is aware of them and can coordinate when and where to show up so that they can get care,” said Yun. “Afterwards they can go back to their ship quickly so they can perform their jobs.”

Under the new PM process both Fleet and Operational Forces Medical Liaison Services (OFMLS) must complete special checklists to ensure adherence of transfer guidelines. Requirements include ensuring that there is “doc-to-doc” communication, and the Fleet surgeon is notified prior to disposition and completed checklist is uploaded to the Global Teleconsultation Portal (GTP).

“We now have a way to use a standard process that must be used by all ships in the fleet as well as any Navy Medicine Readiness and Training Command (NMRTC) regardless of their location or time zone,” said Brian McCormick, Director, Improvement Sciences, Chief Improvement Science Officer for Navy Medicine, and a charter member of the PM action team. “This standard practice now allows Navy Medicine to be able to track these sailors, ensure they receive the right care, and keep operational commands informed of their sailors condition and status within 30 minutes of arrival at a definitive care facility.”

Built on the successes of the pilot program, phase 2 saw enterprise-wide implementation of processes including improved systematic data collection allowing to better monitor process performance. As of June 2023, all OFMLS – CONUS and OCONUS – at NMRTCs have implemented and validated PM processes.

“As we're starting to see the data come in, we are learning that this is a good process,” said Cmdr. Elegant Bigornia, Director for Executive Medicine at NMRTC San Diego and Chair of the BUMED Operational Forces Medical Liaison Service Clinical Sub-Community. “It is improving communication and closing up a lot of those gaps in communication while allowing for feedback for continuous improvement.”

The process has also helped minimize cases of so-called “displaced” Sailors and Marines. At NMC San Diego alone, over 92 percent of patients evacuated arrive with a non-medical attendant (“battle buddy,”) and up to 78 percent of them have travel orders and government travel charge cards (GTCC) prior to movement; this compares to just 50 percent having battle buddies and 15 percent travelling with orders and a GTCC prior to launching phase 2 in December 2022.

For Yun this PM evolution has been significant. “It's closed loop in communication,” said Yun. “It's seeing that we know the person's coming. We can set up. We can make sure that the appropriate specialist is aware on the MTF side.”

What’s next for the project? With phase 2 now complete Cmdr. Bigornia sees the future as sustainment and institutionalization.

“We are working on embedding this process in instruction on both the fleet and the BUMED side so that it is codified,” said Bigornia. “We operate in very dangerous environments and unexpected injuries and illness happen. We have to have a good process to make sure that we identify the issues quickly and can communicate the need and get that Sailor or Marine to the level of care that the need in a timely manner.”
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