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Posted at 11:45 AM ET, 09/11/2009

The New Walter Reed: Less Than 'World Class'?

By washingtonpost.com editors

By Stephen Schimpff
Columbia


We Americans owe our servicemen and women, especially our wounded warriors, the very best in medical care. With the construction of a “new Walter Reed” in Bethesda, we have a unique opportunity to ensure that they get such world-class care. But for that to happen, much more needs to be done.

Care for military personnel in the Washington area has long been provided by Walter Reed Army Medical Center in Washington and National Naval Medical Center in Bethesda. But in 2005, the Base Realignment and Closure Commission (BRAC) mandated consolidation into a new Walter Reed National Military Medical Center on the grounds of the naval hospital. This facility will provide primary and more complex care to all military personnel who live in the northern half of the capital area, as well as tertiary care — high-level specialty care — to those from the entire region, including complete care for wounded service members.

About a year ago, following reports that the new facility was not on track to meet a stated requirement of “world class,” Congress passed legislation calling for a review by a subcommittee of the Defense Health Board. I was nominated to join this 15-member group by Sen. Benjamin L. Cardin (D-Md.).

There is much to commend in the work that has been done so far. For example, the view of the facility from Wisconsin Avenue will be very pleasing, with the iconic 1930s tower flanked by a new outpatient building and a revamped, extended inpatient building — and these will provide not only good but excellent care. But a master facility plan has never been done for the campus, which currently serves multiple functions and includes many older buildings that, over time, should be replaced in an orderly manner. During our review, we were told that such a plan was not within the scope of the BRAC budget.

Similarly, no analysis has been performed to determine future needs based on local demographic changes (the number of retired military personnel in the area is increasing), changing types of wounds (such as from improvised explosive devices) or advances in the delivery of medical care. Instead, the consolidation was planned using a static approach, whereby the functions performed at Walter Reed were simply shifted to the future facilities. Again, the rationale we were given for this was that the BRAC law did not allow for any other approach.

This has led to other issues. For example, three new operating rooms are being built for the new medical center. That’s good; they will be up to modern size and technology standards. But seven older ones to be incorporated from the naval hospital will remain as they were constructed — too small for all of today’s operating room technologies — and will depend on nearly 25-year-old air-handling systems. Logically, this is the moment to update those operating rooms. We also found that there would be no in-house simulation laboratories for learning and practicing operating room procedures and other hard-to-master technical skills, ostensibly because there is an excellent simulation facility a few miles away. These learning labs are critical to a modern hospital, but they must be immediately accessible to trainees to be useful.

One more issue: Most of the beds at the naval hospital are semi-private. Today the standard is one patient per room, not just for privacy but for infection control and other medical imperatives. Only one floor of the new facility will be renovated to have private rooms. On the remaining floors are two-bed rooms and bathrooms that are too small for those with amputations or in a wheelchair. These should also be renovated, for obvious reasons.

Our report recently went to Congress. I hope it will encourage those in decision-making capacities to move ahead with a master facility plan, a true demand analysis and appropriate renovations to ensure that these issues and others get resolved before the new Walter Reed opens in a few years. It may require some rebudgeting, but our military personnel deserve no less than world-class facilities.

The writer is a retired CEO of the University of Maryland Medical Center and author of “The Future of Medicine — Megatrends in Healthcare.”

By washingtonpost.com editors  | September 11, 2009; 11:45 AM ET
 
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Comments

Mr. Schimpff, there is no way your discussion can be considered complete, omitting as it does any reference to the new hospital being built at Fort Belvoir, Va., as a part Walter Reed's realignment. Your commentary would have the reader believe that everything at the old WRAMC will move to the new facility at Bethesda, which SURELY you know is not the case. Why have you left out any mention of the new facility being built at Belvoir, to which all Primary and Secondary care will transfer, and provided a commentary which appears to be written more to alarm than to inform or evoke reasoned discussion?

Posted by: carrdona | September 12, 2009 6:10 AM | Report abuse

The closure of Walter Reed does indeed entail transfer of functions to two locations – a new Walter Reed National Military Medical Center [WRNMMC] serving all services on the grounds of the current National Naval Medical Center in Bethesda and an entirely new facility at Fort Belvoir, just south of Mount Vernon. The Fort Belvoir site will be for primary care and secondary care of those who live in the southern part of the national capital area. The WRNMMC will serve the same purpose for those who live in the northern half of the area and in addition serve the tertiary needs of all plus care for wounded service personnel. The panel found that the Fort Belvoir facility was well designed and planned with minimal issues for resolution. The Bethesda facility is much more complex, requires the integration of not only multiple cultures and practice patterns but also the difficult requirement of building a new outpatient unit on a crowed campus, adding to an older inpatient hospital and retrofitting it all to work together. The care will undoubtedly be excellent when it opens in September, 2011 but some additional attention to the facility plan now will make it much better.

Posted by: StephenSchimpffMD | September 12, 2009 12:03 PM | Report abuse

O.K., let's all admit some basic things about access to care. As you know TRICARE dictates where you receive your care. I wonder exactly who will be receiving care at these facilities. It appears whenever a facility wants to justify their spending, they change the enrollment criteria. Yes they are buiding a new facility at Ft Belvoir but who will be allowed access to primary care ? Also, if you're going to have a world class facility, staff it world class customer service. I've been to Walter Reed and Ft Belvoir and Bethesda NNMC. They are WORLDS apart at the customer service level. Look for a clinic at NNMC and they call someone to escort you. Try to find the allergy "trailer" at Ft Belvoir and you may end up at the Commissary. And at WRAMC just bring your GPS and you'll be fine....if you find parking!! World class care starts before the patient makes it to the clinic. All I'm saying is I hope that these facilities step up the customer service to match the facelift on the facilities.

Posted by: drillsergeant78234 | September 13, 2009 9:50 AM | Report abuse

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