Page 20 - JSOM Fall 2022

FIGURE 3 Active duty and veteran experience: Integrated approach. of PREP. PREP provides a robust program of mTBI symptom
assessment and evaluation. The arrival of COVID­19 required
the development of a virtual program to ensure continuity of
care.

The remaining PRCs are implementing similar programs at
their facilities. As described above, the rehabilitation nursing
workforce are key clinicians to PREP’s success. The NP’s role
is integral to the cohesiveness of the program. The roles of the
RN CCC and specialized rehabilitation nurses are fundamen­
tal to the patient care experience. The HUC is a strongly rec­
ommended position to facilitate communication and unit flow.

Acknowledgments
The authors would like to acknowledge the assistance of
the following people in preparation of this article: Priscilla
Program Modifications Due to COVID-19 L Stephenson, MSLS, MSEd, AHIP, FMLA Chief of Library
The onset of COVID­19 in early 2020 required changes at the Service, Tampa, VA, and Jessica Wentworth, Lead Medical
Tampa, FL, VA. The PREP inpatients were discharged home to Support Assistant PMRS, Polytrauma Rehabilitation Center,
be with their families, continuing their established treatment Tampa, VA.
as outpatients. During this time period, VA telecommunica­
tion platforms were being established and modified to meet Disclosures
the ever­increasing demands of staff working remotely while The authors have indicated they have no financial relation­
continuing to treat patients via telemedicine. The use of tele­ ships relevant to this article to disclose.
health technologies is an invaluable tool in providing health
services and meeting the needs of patients, while avoiding di­ Disclaimer
The views expressed in this presentation are those of the
rect contact in effort to mitigate the risk of COVID­19. 9
authors and do not necessarily reflect official policy of Vet­
erans Affairs, Department of Defense, or the United States
When it became apparent that the pandemic was going to Government.
continue longer than originally anticipated, a virtual intensive
outpatient PREP program was established in July 2020. By the References
end of September 2020, this virtual program had provided ser­ 1. US Department of Veterans Affairs. Polytrauma/TBI System of
vice to 12 virtual patients. There were some unique challenges Care. https://www.polytrauma.va.gov/system­of­care/index.asp.
in the virtual outpatient program. An immediate primary chal­ Accessed 11 July 2022.
lenge was to assist patients in dealing with competing personal 2. US Congress. Public Law 108­422, Section 302:7327. 30 Novem­
ber 2004. https://www.govinfo.gov/content/pkg/PLAW­108publ
demands for their time and attention, such as work, appoint­ 422/pdf/PLAW­108publ422.pdf . Accessed 11 July 2022.
ments with outside community medical providers, surgeries, 3. MacGregor AJ, Zouris JM, Watrous JR, et al. Multimorbidity and
new injuries, family, children – including homeschooling and quality of life after blast­related injury among US military person­
house or car needs (e.g., leaking roof, car maintenance). nel: a cluster analysis of retrospective data. BMC Public Health.
2020;20(1):578.
4. Smith EN, Young MD, Crum AJ. Stress. mindsets, and success in
With the need to rely on virtual care, the PREP team members Navy SEALs Special Warfare Training. Front Psychol. 2020;10:
encountered new experiences and developed enhanced skill 2962.
sets. The PREP staff identified the need to accommodate the 5. Baker MS. Casualties of the Global War on Terror and their future
increased time required by virtual therapy and its logistical impact on health care and society: a looming public health crisis.
Mil Med. 2014;179(4):348–355.
and technical issues. Individual weekly rounds were conducted 6. Commission on the Accreditation of Rehabilitation Facilities
with each patient. An hour of time was blocked for the Vet­ (CARF) International. About CARF. http://www.carf.org/home/.
erans Video Connect teleconference meetings with providers, Accessed 11 July 2022.
although some providers must continue to see patients face to 7. Military.com. Special Operations Forces Center. https://www.
military.com/special­operations. Accessed 11 July 2022.
face to complete evaluations (e.g., TBI optometry and TBI au­ 8. US Department of Veterans Affairs. VHA Directive 1172.01 Poly-
diology). Overall, evaluations now require about 4–5 weeks in trauma System of Care. Transmittal Sheet. 24 January 2019. https://
the outpatient setting, in comparison to the 3­week inpatient www.va.gov/OPTOMETRY/docs/VHA_Directive_1172­01_Poly
evaluation program. trauma_System_of_Care_1172_01_D_2019­01­24.pdf. Accessed
11 July 2022.
9. Monaghesh E, Hajizadeh A. The role of telehealth during COVID­19
The PREP interdisciplinary team holds joint virtual weekly outbreak: a systematic review based on current evidence. BMC Pub-
meetings to discuss the care plans for current patients. While lic Health 2020;20(1):1193.
the preferred and optimal treatment setting for this population
is inpatient, the PREP team has successfully created a modified
outpatient program, offering care during the current environ­
ment, which may be replicated for future needs.
PREP Team James A.
Haley Veterans’ Hospital
Summary Tampa, Florida
The complex symptomology and chronic sequelae of mTBI re­
lated to GWOT led to the VA’s development and implementation

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