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Just when you thought the VHA Innovation Experience (iEX) Virtual Series couldn’t get any more exciting, the VHA Shark Tank Competition returns! This year brings a new set of VHA Shark Tank priorities and finalists for Medical Center and VISN Director Sharks to sink their teeth into and a redesigned, fin-credible event that’s sure to be more captivating than ever before. The best part? You can see it all live at this year’s iEX Marquee Event, October 27–28.

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The VHA Shark Tank Competition is bringing frontline innovators into a rousing shark tank-style pitch competition to help spread their work to impact even more Veterans lives. Winning Promising Practices have been replicated more than 830 times across the country with 10 of them moving into National Diffusion and helping change Veteran care for the better. If you receive care at VA, chances are your experience has been impacted by innovations from the VHA Shark Tank Competition.

This year, 16 Finalists were selected from more than 320 applicants to pitch their Promising Practices in a redesigned format that is built to deliver even more live excitement and fun. Several new elements have been added to this year’s VHA Shark Tank competition, including an extended Medical Center and VISN Director (the Sharks) bidding period prior to the event and the new Director’s Pick!

These new VHA Shark Tank elements provide the opportunity for two emerging technology practices from the VHA Innovation Ecosystem and the Office of the Healthcare Innovation and Learning to participate as Finalists in the Competition. At iEX, the 16 Finalists will have three minutes to pitch their innovations to the Sharks – with Veterans and the health care industry watching – and then find out if their innovations have been selected.

The VHA Shark Tank is a can’t-miss event that you can register for right now! Tune in to discover which of the below innovations will be in the next cohort of Diffusion of Excellence!

Billing Resolution Center – VA Central Ohio Healthcare System (HCS)

Beginning July of 2020, VA Central Ohio HCS began a process to resolve billing concerns resulting in over $2.5 million dollars in erroneous claims corrected for over 300 Veterans to date. The Resolution team instituted monthly meetings with the top five (by disbursed amount) vendors and encouraged utilization of available resources, including Health Share Referral Management (HSRM). The program established weekly meetings with all staff involved in billing to ensure resolution of issues and addressing of erroneous billing situations. The team hired a billing resolution specialist as AMSA (Advanced Medical Support Specialist) to meet with Veterans in-person. Consolidated Patient Account Center (CPAC) staff are now imbedded and focused on VA copayment education and repayment options. By reaching out to vendors in the community, the practice is re-establishing trust and building relationships that are instrumental as we navigate new community care needs. The program has seen Survey of Healthcare Experiences of Patients (SHEP) scores related to community care billing increase in almost all areas to exceed national standards since implementation of the Billing Resolution Center.

Cancer Prevention at Your Fingertips, Empowering Veterans Through Mobile Application – Michael E. DeBakey VA Medical Center (VAMC)

In the United States, Colorectal Cancer (CRC) is the third leading cause of cancer-related deaths in men and women and the second most common cause of cancer deaths when men and women are combined. As a “digital front door” to address this phenomenon, Annie uses a series of navigational reminders for colonoscopies’ optimal performance, devising an inclusive means of combating the growing burden of cancer through early detection and prevention. Now, the organization has in place the components of an effective no-show mitigation strategy, driving our strategic priorities as a High-Reliability Organization (HRO), as Annie empowers, educates and engages each Veteran from the convenience of their home.

Colorectal Cancer Screening with Programmatic Mailed Fecal Immunochemical Test (FIT) – National Gastroenterology Program Office

Screening is proven to reduce mortality from colorectal cancer (CRC), the second leading cause of cancer death in the United States. Unfortunately, hundreds of thousands of Veterans are unscreened, and the COVID-19 pandemic has exacerbated this problem, with approximately 1.6 million Veterans due for screening in 2021. To address this still-growing backlog, we have initiated a program to mail Fecal Immunochemical Test (“FIT”) kits for CRC screening directly to our Veterans to use in their homes and mail back for analysis; Veteran and provider acceptance has been very positive.

We believe our FIT-first approach, modeled after the successful Kaiser Permanente program, will increase CRC screening adherence, reduce overall costs, increase colonoscopy access for Veterans with the highest risk for CRC, and ultimately save lives.

Compassionate Contact Corps – VA Central Ohio HCS

The Compassionate Contact Corps is a social prescription program that offers friendly phone and video visits between trained volunteers and Veterans. The volunteer calls their matched Veteran once per week to provide compassionate conversation and companionship. This program has proven to reduce loneliness and improve overall well-being in Veterans.

Duty to Assist – VA Northeast Ohio HCS

Veterans and providers are unaware of the presumptive conditions and potential benefits eligibility associated with Agent Orange and contaminated water at Camp Lejeune. As a result of this practice, over 800 Veterans have been educated of the presumptive conditions for Agent Orange & Camp Lejeune, their potential eligibility for benefits, the importance of filing for benefits, and getting connected to those who can assist with the application process. The gap between the VBA, VHA and VSC/VSO is closed through this practice, allowing us to serve our Veterans better.

Fall Prevention System – The National Center for Collaborative Healthcare Innovation (NCCHI)

Falls among hospital inpatients are common, generally ranging from 2.3 to 7 falls per 1,000 patient days. Approximately 30% of inpatient falls result in injury, with 4% to 6% resulting in serious injury. These serious fall-related injuries can include fractures, subdural hematomas, excessive bleeding and even death.

The prevention of falls in the hospital setting is important for patient safety and public health issues. NCCHI is working to assess, integrate and quantify novel fall prevention technology. Specifically, a system validated for our Veteran population, VA Infrastructure, as well as clinical and operational workflow.

Among these technologies, NCCHI is collaborating with a medical company on an exciting project that utilizes its smart integrated sock sensor system to alert nurses when a fall-risk patient attempts to get out of bed. The design is optimized for efficient clinical response, and nurses are empowered to be in the right place at the right time.

Fluoroquinolones: A Patient Safety Priority – VA Butler HCS

Despite a plethora of safety warnings and concerns, including the first warning of Achilles tendon rupture and the most recent of aortic aneurysm, fluoroquinolones continue to be one of the most common antibiotic classes prescribed in the United States. Through a VISN-wide approach utilizing health care technology, VISN 4 sought to empower prescribers to heed these safety warnings and mitigate patient harm. By using a standardized note in the electronic medical record, VISN 4 implemented an intuitive, simple, and self-sustaining initiative that decreased its outpatient fluoroquinolone prescriptions by 46%.

Implementation of Syringe Service Programs (“SSPs”) – Edward Hines Jr. VA Hospital

Overall, our aim is to better apply harm reduction with the implementation of Syringe Service Programs. We aim to encompass people who use drugs (PWUD) – broadly speaking, meaning injection and non-injection routes (snorting, smoking) and opioids and non-opioids (methamphetamine, cocaine, etc.). Material items will include sterile equipment, supplies, naloxone and patient education. Perhaps more important is the linkage to health care, in general, including primary and specialty care. Overall, we aim to engage a stigmatized and vulnerable population and improve their long-term health and well-being.

We have escalated this project from the local level and a smaller, rural-serving VA in Danville, IL, (closest SSP >1 hour away) to one that has national support (OMHSP, HHRC, OGC), and many facilities nationwide are rolling out. We are involved in a VA-funded research study to evaluate SSP and Harm Reduction implementation in VA. Overall, it’s an opportunity to bring culture change to VA and for VA to serve as a model for other large, federal institutions to follow.

Mini-Cog screening tool: Early identification of Patient with Cognitive Impairment – The Villages Outpatient Clinic

The Mini-Cog© is an instrument that can increase the detection of cognitive impairment in older adults in just three minutes. It can be used effectively after a brief training in both health care and community settings.

The goal of screening for cognitive impairment in primary care is to find patients whose cognitive deficits have gone unnoticed or unrecorded in routine clinical encounters. Symptoms may be severe enough to interfere with the patient’s self-care and medical management.

Nursing implementation of the mini-cog tool provides an easy and consistent process for early recognition of cognitive impairment. This results in the appropriate referrals to provide early diagnosis, differential and treatment. Early treatment can provide improved patient outcomes by slowing or delaying disease progression, which has been shown to improve the quality of life for both the patient and their family while allowing additional time for important decision-making and planning.

Perioperative Nurse Residency Program – VA Northern California HCS

For three years, our Perioperative Nurse Residency program has successfully cross-trained registered nurses to the operating room as fully independent circulating and scrub nurses as planned replacements for outgoing nurses entering retirement. Our program was further validated when four of our six graduates from the 2018 and 2019 cohorts have undertaken service lead and/or backup lead roles, now responsible for all supplies and equipment for that surgical specialty. Additionally, the quality of the program training has enabled us to support an 8.5% increase in operating hours from 2018 to 2020. With the graduation of our 2020 cohort in May 2021, the program continues with the 2021 cohort scheduled to begin in September.

Team Approach to Decreasing Injuries Related to Intimate Partner Violence – Jesse Brown VAMC

The Relationship Health & Safety (RHS) screening protocol/template, a CPRS available IPV screening tool, was installed and activated as a clinical reminder in three highly motivated practice settings during the height of COVID. While fewer people were able or willing to leave their homes due to COVID precautions and opportunities to reach out for help diminished, the point of contact which remained consistent for help-seekers was the medical field. By rolling out universal IPV screening during this critical time, we increased opportunities by health professionals to capture Veterans who may need help by 2050% as compared to the previous six months.

Team-supported, EHR-leveraged, Active Management (TEAM) for Hypertension – Durham VA HCS

TEAM is an evidence-based, adaptable and economically sustainable telehealth program that improves blood pressure control. TEAM’s flexible design and incorporation of existing VA tools support equitable impact for all Veterans, particularly among underrepresented minorities. To date, TEAM has been adopted by seven clinics, reaching a total of over 800 Veterans with an overall average reduction in systolic blood pressure by 11mmHg. TEAM’s implementation, adaptations and linkages to effective VA resources achieve improved blood pressure control while simultaneously reducing barriers to care and increases Veteran engagement with VA.

THRIVE: Transforming Health and Resiliency through Integration of Values-based Experiences – James A. Haley Veterans Hospital

THRIVE is a 14-week curriculum-based Shared Medical Appointment for Veterans developed from evidence-based principles of Whole Health, Positive Psychology, and Acceptance & Commitment Therapy. THRIVE is a Whole Health clinical offering that improves Veterans’ health, well-being, and health care experience; it enhances employee satisfaction and retention and improves the facility’s bottom line. In a 100% virtual platform, THRIVE enables more Veterans to experience the benefits of an effective program that builds resilience, improves health and creates community.

VA Operating Room Preparation Standardization – Lexington VAMC

Operating Room setups were found to be nearly 100% variable and inefficient, creating frustration amongst staff when switching for lunches, breaks and shifts. By working with key stakeholders, standard operating procedures utilizing visual management were created and introduced. This decreased variation to nearly zero and increased efficiency by nearly 50%.

Virtual Home-Based Cardiac Rehabilitation (Smart HEART)

Smart HEART (Health Education and Rehab Technology) Virtual Home-Based Cardiac Rehabilitation helps some of the most vulnerable at-risk Veterans who have had hospitalizations for heart disease. We use connected technology, such as fitness trackers and a smartphone app to remotely connect Veterans at home with their VA cardiology team. We use a sophisticated dashboard system with programmed alerts to improve the efficiency of patient care and prevent adverse outcomes.

Virtual Reality for Pain and Anxiety Management – Western North Carolina VA HCS

Virtual Reality as a distraction modality utilizes three-dimensional, computer-generated environments and 360-degree video footage in an immersive head-mounted display to transport Veterans to a world where their negative stressors do not exist. This capability enables licensed clinical staff to aid Veterans with pain and anxiety management, improve relaxation, and make the experience of being in a healthcare facility a more positive one. Virtual environments include interactive games, peaceful natural environments, and even footage familiar to our Veterans – Western North Carolina’s well-known mountain tops to make our Veterans feel more at home within our walls. Since project planning began in late 2017, over 300 sessions have been completed in multiple patient areas, 58.3% of participating Veterans experienced a decrease in acute and/or chronic pain, and 92.5% of Veterans experienced a decrease in Stress/Anxiety levels.

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