"This has been an unforgettable year. I have worked closely with the leadership team in the Medicine Service to implement many changes in a very short time span. The volunteerism and openness to change demonstrated by all involved have been incredible. We have been able to cut the red tape and delays in a manner I would have thought impossible before the pandemic. I hope this will continue long after the pandemic, allowing us to continue evolving and improving the care we provide our nation’s Veterans." - Sanjay Saint, MD, MPH
The VA Ann Arbor Healthcare System (VAAAHS) continued to experience steady outpatient and inpatient activity in 2020, with our campus handling 777,856 outpatient encounters and 86,451 inpatient encounters.
All Hands on Deck
VAAAHS is part of the Veterans Health Administration, the largest integrated health care system in the country and one of the largest in the world, with about 170 hospitals and 1,000 clinics and other ambulatory care centers. Our Medicine Service has approximately 360 staff including approximately 160 physicians and approximately 200 non-physicians (respiratory therapists, nurses, administrators, dialysis technicians). The service is divided into 11 sections, each led by a section chief who is a physician. All of the physicians in the Medicine Service are faculty members from the Department of Internal Medicine. As COVID-19 is an acute respiratory tract illness, the patients admitted to the hospital - whether on the floor or in the intensive care unit - have been cared for primarily by doctors and trainees in the Medicine Service. In terms of trainees, we have subspecialty fellows and house officers who work under the supervision of attending physicians. Advanced practice providers including physician assistants and nurse practitioners are also integral members of our team.
As COVID-19 surged and became a national emergency, we had to throw out carefully prepared attending and learner schedules, and replace them with an ‘all-healthy-hands-on-deck’ philosophy. Before COVID, we had four resident teams with one attending physician, one senior medical resident, two interns (sometimes a third from psychiatry) and three to four medical students. Each team could care for up to 16 patients.
When medical students were removed from clinical duties on March 17, 2020, following guidance from the American Association of Medical Colleges, our internal medicine residency implemented a new approach in which the four resident teams each consisted of one senior medical resident, one intern and one non-medicine “intern equivalent” with a rotating weekly schedule. We also established three new teams including one team of hospitalists to focus on the care of COVID-19 patients in a geographically localized ward.
Our Fourth Mission
For the first time in its 67-year history, on April 5, 2020, VAAAHS began accepting non-Veteran patient transfers from overburdened area hospitals. In this historic move, the John D. Dingell VA Medical Center in Detroit and the VAAAHS each activated their response to the VA’s “Fourth Mission”: To improve the nation’s preparedness for response to national emergencies and to support local critical needs to non-Veterans in times of crisis.
Given this unique opportunity, a team of our VAAAHS researchers conducted a survey to better understand non-Veteran perceptions of the quality of care provided at VA medical centers. This first-of-its-kind study, published in the Journal of General Internal Medicine, found that non-Veterans perceived the VA favorably in terms of overall care, physician care, nursing care, and communication when compared to transferring facilities and other hospitals. In general, non-Veterans were highly satisfied with the care received at the VA and often preferred VA care over non-VA care. The paper’s first author was our Chief of Hospital Medicine, Ashwin Gupta, MD, Assistant Professor in the Division of Hospital Medicine.
COVID-19 Research Highlight
The landscape of caring for hospitalized patients shifted dramatically during the pandemic. Nathan Houchens, MD, Associate Chief of Medicine at VAAAHS and an Associate Professor in the Division of Hospital Medicine, and Renuka Tipirneni, MD, MSc, Assistant Professor in the Division of General Medicine, published an article in the Journal of Hospital Medicine titled “Compassionate Communication Amid the COVID-19 Pandemic” that shares strategies on how to communicate with both patients and families despite the challenges of COVID.
First Fisher House Opens
Despite the many pauses caused by the pandemic, the first Fisher House in the state of Michigan officially opened as planned in June 2020, a short walk from the VA Ann Arbor Healthcare Center. With this new facility, up to 16 families at a time can stay free of charge in this home away from home, allowing them to be close to their loved ones at a very stressful time - during hospitalization at the VAAAHS. The 16-suite, 13,400-square-foot “comfort home” is one of 87 Fisher Houses operating in the United States and Europe.
During 2020, the following faculty took on new appointments:
Awards & Recognition
Our VAAAHS Internal Medicine faculty are regularly honored and recognized for their expertise in Michigan and across the country:
- Eve Kerr, MD, MPH received the 2020 Society of General Internal Medicine John Eisenberg National Award for Career Achievement in Research, an award that recognizes senior members whose innovative research has changed the way we care for patients, conduct research, or educate students
- Grace Su, MD received the Roger J. Grekin Research Award from VAAAHS. This award recognizes outstanding clinical researchers who contribute to the VA research mission through excellence in clinical care, research, mentorship, and leadership