Audio VA clinics using technology to ease patient overload (story audio) Photos Dr. Melvin Thomas consults with a patient on the phone Dave Sabie, a VA patient The VA hospital in Sioux Falls is being expanded Resources Sioux Falls VA Department of Veterans Affairs Your Voice Join the conversation with other MPR listeners in the News Forum.

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VA clinics using technology to ease patient overload
by Cara Hetland, Minnesota Public Radio
March 4, 2003

Dr. Melvin Thomas of the Sioux Falls VA Hospital consults with a patient on the phone. Thomas says even though he's not seeing his patients as often, he or his nurse are talking with them more frequently. (MPR Photo/Cara Hetland)

Veterans Affairs medical centers have seen an explosion in the number of patients across the country. Patient loads have increased by as much as 60 percent over the last seven years. The Sioux Falls VA clinic serves veterans from one of the largest regions in the country, and 23,000 patients are enrolled there. Many drive hours to see a doctor. Nationally, the V.A. is looking for ways to be more efficient. The Sioux Falls clinic is already changing things. Doctors are using new techniques to treat more patients every day.

Sioux Falls, S.D. — David Sabie sits in a large waiting area at the Sioux Falls VA Hospital. He's here for a regular treatment for respiratory problems. Sabie speaks in short choppy sentences with labored breath. He comes in every three weeks to get an intravenous treatment.

Sabie was exposed to chemicals when he served in the Army in the late 1980s. For 12 years he's received regular treatments, and he's on a waiting list for a lung transplant. Sabie comes to the VA daily for physical therapy. He's here so often, he knows when to avoid the rush.

"It's usually busy on Mondays and Fridays," says Sabie. "So I get my treatment during the middle of the week. It makes it easier on them and easier on me."

	Dave Sabie, a VA patient

The mornings are usually "standing room only" in the primary care clinic. About 135 veterans come in each day. Most are elderly with heart disease, emphysema, cancer or diabetes. Congress recently opened up the eligibility requirements, allowing cheaper health care for veterans. Now, the Sioux Falls clinic has 2,400 people on a waiting list to be seen by a doctor.

So the VA is making some changes. Patients used to see whichever doctor was available. But now, each patient will be assigned a primary care physician. Patient records, complete with doctor's notes and lab histories, are all computerized. Doctors are leaving appointments open in their schedule for patients who need to be seen right away. And they're following up with patients by phone.

Melvin Thomas is chief of primary care medicine and specialty care at the Sioux Falls VA Hospital. On this day, Thomas is questioning a patient about a rash she has on her hands and feet. As they talk by phone, Thomas tells her to come in the next day before he prescribes treatment. Thomas says the phone lets him give his patients better care.

"I can see about 8 or 10 patients in my phone clinic in an hour, where it would take me an afternoon about to see those patients in my regular clinic," says Thomas.

	The VA hospital in Sioux Falls is being expanded

Thomas says his phone clinic lets him check on patients between office visits. He can send patients to the lab and review results with them over the phone, or he can monitor medications without requiring an office visit. Thomas says it opens up his schedule for his sicker patients, and tends to get patients involved in their own care.

Thomas says even though he's not seeing his patients as often, he or his nurse are talking with them more frequently. He's able to keep better track of his heavy patient load and work in new patients from the backlog. Thomas says with better communication, patients are comfortable with longer intervals between office visits.

"The patients feel more connected," he says. "If a patient feels they have access either through the nurse or to the physician, they will feel more comfortable with their care. And in actual fact, they probably will call less in the long run than they would have otherwise."

The Sioux Falls VA has been working with this new system of care for about a year. Not all the VA clinics have bought in to the new method. Thomas says he was even surprised to see how well it worked.

The Sioux Falls VA is adding a new physician and nurse practitioner. Construction is underway to expand the facility, more than doubling the number of exam rooms. VA staff are also making a promise -- that they'll see all 2,400 patients on the waiting list by Oct. 1.

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