September 22, 2015

Sgt. Shaft caricatureDear Sgt Shaft
How does the VA medical center in Washington stack up against the other local medical facilities?

Harry R
Takoma Park,  MD

Dear Harry
Quite well from my perspective.  I understand that  Cardiac surgeons at the Washington DC Veterans Affairs Medical Center are ushering in a new era of hospital patient care and safety with the implementation of a ground-breaking test used to predict a patient’s risk for acute kidney injury (AKI), a dangerous and costly complication that can present a greater threat than a heart attack.

The medical center is the first hospital in the Mid-Atlantic Region and the Washington DC Metro Area to deploy the NephroCheck Test made by a San Diego-based company. The novel test detects and measures two biomarkers known as tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP-7) then produces an AKI Risk Score that can alert physicians to a patient’s risk of developing moderate to severe AKI.

“Patient safety and quality of care are our highest priorities and I hope and expect that this could be a game-changer in terms of protecting our patients from AKI,” said Carlos Palant, M.D., chief of the Renal Section, and professor of medicine at the George Washington University School of Medicine.  “This is one more example of the VA taking a leadership role in bringing cutting edge medicine to patients.”

Acute kidney injury often occurs in conjunction with surgery, trauma or infection, however a lack of symptoms can limit physicians’ ability to prevent onset and manage the condition. A 2014 study of hospitalized U.S. Veterans found that those discharged with a diagnosis of AKI had twice the mortality rate of those diagnosed with myocardial infarction (heart attack).

Doctors at the Washington DC Veterans Affairs Medical Center intend to use the test with cardiovascular surgery and intensive care patients.

“Cardiac surgery patients with either chronic kidney disease or dialysis dependence have increased perioperative morbidity and mortality, and half the long-term survival outcome at five years, compared to patients without preoperative renal disease,” said Dr. Gregory Trachiotis, who serves as chief, Cardiac Surgery at the DC Veterans Affairs Medical Center as well as chief of Cardiothoracic Surgery at George Washington University.  “As cardiac surgeons, we have attempted to mitigate the risks of developing AKI; yet this most often occurs after the fact.

“Methods of predicting the occurrence of AKI, and implementing therapy to limit or alter the degree of AKI, may not only improve short-term outcomes, but also potentially improve long-term survival. This test may provide cardiac surgeons and others with this ability.”

About Acute Kidney Injury
Acute Kidney Injury is one of the top 10 hospital in-patient complications most likely to affect mortality, length of stay and costs. Because no therapy exists for AKI, clinicians must focus on prevention and early risk assessment in order to mitigate the threat of long-term consequences.

The incidence of AKI is increasing, and studies suggest that when patients develop AKI the length of hospital stay, costs, readmissions, and mortality can double. Recently, multiple large cohort studies have demonstrated that even patients who survive an episode of AKI are at risk for significant adverse outcomes including dialysis, progression to advanced stages of chronic kidney disease and, or death.


Shaft Notes
Dr. David J. Shulkin and LaVerne Horton Council recently took the oath of office where they will serve respectively as Under Secretary for Health and Assistant Secretary for Information and Technology and Chief Information Officer for the Department of Veterans Affairs (VA).

“Dr. Shulkin and Ms. Council bring stellar experience and exceptionally strong leadership to their posts,” said Secretary of Veterans Affairs Robert A. McDonald. “Both will play critical roles in making VA a stronger organization for America’s Veterans, and I am looking forward to working with them.”

Dr. Shulkin comes to VA immediately from the position of President at Morristown Medical Center, Goryeb Children’s Hospital and Atlantic Rehabilitation Institute, part of Atlantic Health System. Prior to joining Morristown Medical Center and Atlantic Health, Dr. Shulkin served as President and CEO of Beth Israel Medical Center in New York, where he led a financial turnaround and rebuild of the $1.3 billion organization.

As Under Secretary for Health, Dr. Shulkin will direct a health care system with an annual discretionary budget of approximately $60 billion, overseeing the delivery of care to more than 9 million enrolled Veterans. VA, the nation’s largest health care system, employs more than 350,000 total employees including over 305,000 health care professionals and support staff at more than 1,200 sites of care, including hospitals, community based outpatient clinics, nursing homes, domiciliaries and 300 Vet Centers.

Ms. Council most recently held the positions of CEO at Council Advisory Services, LLC and Chair of the National Board of Trustees for the March of Dimes. In December 2011, she retired from Johnson & Johnson after serving as Corporate Vice President and Chief Information Officer for Johnson & Johnson’s global IT group. In this capacity, she was responsible for managing IT and related systems for the $61.6 billion Johnson & Johnson worldwide enterprise. She was a member of the Corporate Global Operating Committee and her organization included more than 250 operating companies with more than 4,000 information technology employees and 7,000 contractors.

Ms. Council earned a Master’s of Business Administration in Operations Management from Illinois State University with a Bachelor of Science in Business from Western Illinois University. In 2010, Ms. Council was presented with a Doctorate of Business Administration, Honoris Causa from Drexel University.

As VA’s Assistant Secretary for Information and Technology and CIO, Ms. Council is the single leadership authority for IT and is the principal advisor to the Secretary on all matters relating to the management of VA’s Office of Information and Technology. She will oversee VA’s $4 billion IT portfolio and more than 8,000 IT employees.

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