Hospitals forge positive change in military medicine

88th Medical Group

What began as a helping partnership between the Wright-Patterson and Dayton Veterans Affairs medical centers became a boost to military medical training and increased care for veterans.

Since early 2021, Dr. (Maj.) Matt Koroscil, director of the Medical Intensive Care Unit, and Dr. (Maj.) Andrew Berglund, chief of Pulmonary Medicine, both from Wright-Patterson Medical Center, have provided ICU coverage at Dayton VA Medical Center as part of a resource-sharing agreement, with the purpose of delivering care during times when the downtown facility was short-staffed.

“This is something that I have wanted to do for a while because we have a VA that is so close to us,” Koroscil said. “The VA is larger than Wright-Patterson Medical Center and it has more resources than we do in terms of the size of their ICU and their larger inpatient units.”

Both doctors specialize in pulmonary medicine, which diagnoses and treats diseases of the lungs and other parts of the respiratory system.

“The VA and Wright-Patterson partnership has been a very beneficial and rewarding opportunity that we were able to start,” Berglund said. “It allows us to provide excellent care to our veterans.”

Maintaining proficiency

For physicians to maintain their medical-readiness skills performing specialized techniques, it takes practice, and lots of it.

According to Koroscil, physicians typically work on their own time at local hospitals to stay up on procedures, on top of already long hours and on-call shifts.

Wright-Patterson Medical Center is one of the largest military medical facilities in the country, but unfortunately for training purposes, lacks the volume of patients needing specialized procedures. Dayton VA Medical Center has the patient volume but limited staff.

Koroscil had an idea that would benefit both medical centers.

Intensivists from Wright-Patterson would work at Dayton VA Medical Center to gain extra experience with procedures. In turn, that would help prepare physicians from both facilities to provide the best possible critical and pulmonary care to their patients

“First and foremost, this partnership has helped us with our staffing needs and ultimately improved the access time for the veterans,” said Dr. Sangeeta Srivastava, Dayton VA Medical Center’s assistant chief of medicine. “Wright-Patterson Medical Center providers have an excellent understanding about the needs of our veteran population.”

When they started in June 2021, the majority of ICU cases the doctors treated were for COVID-19, similar to most intensive care units across the country.

During the Delta wave, most patients had severe COVID-19 respiratory failure.

“The past two years have been challenging in many ways with the sheer volume and acuity of COVID-19 patients we were asked to care for,” Berglund said.

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A large portion of nurses were deployed at the time, making ICU coverage limited, along with many respiratory therapists who were part of COVID-19 teams sent all over the U.S. and overseas.

“I was deployed and despite how busy things were, Dr. Berglund still covered both the Dayton VA and Wright-Patterson Medical Center while I was gone for nearly three months providing care,” Koroscil said.

The goal with Dayton VA Medical Center is to keep the rotation going for all the pulmonary doctors at Wright-Patterson Medical Center, even with one physician usually deployed at all times, Koroscil added.

Expanded roles improve cancer care

Right now, they are fully integrated into Dayton VA Medical Center for ICU and pulmonary medicine coverage with the additions of Dr. (Maj.) Adam Young and Dr. (Maj.) Rohini Chatterjee from Wright-Patterson Medical Center.

Koroscil, Berglund, Young and Rohini spend about 180 hours a month at the Dayton VA Medical Center, making rounds in the ICU and conducting inpatient-pulmonary consultations with their residents.

“They are excellent clinicians and are well liked by the internal medicine resident physicians for their teaching skills,” Srivastava said. “Overall, this partnership has not only enhanced the care of the veterans and the efficiency of the section, it has also improved the teaching of the internal medicine residents and medical students.”

“We initially started providing critical-care coverage for the VA but have since expanded our roles to include taking care of lung cancer patients and other pulmonary diseases,” Berglund said.

Years ago, there were significant delays in cancer diagnoses and therapy, according to Koroscil. Many cases are diagnosed in the advanced stage. However, lung cancer therapy has evolved significantly over the past decade and newer targeted medications allow less toxicity and improved survival.

He said expediting the staging and diagnosis is important in lung cancer. The VA system has a large lung cancer population and part of the Wright-Patt team’s role is to assist in diagnosis and facilitate earlier management.

The number of patients the VA normally sends to the civilian sector for pulmonary consultations has been greatly reduced, he added, because Wright-Patterson Medical Center is able to perform expedited bronchoscopy at its lung cancer diagnosis and staging facility.

In addition, all cases, even if the VA is performing cancer therapy, are presented at the 88th Medical Group’s tumor board, which involves oncologists and radiation oncologists, Koroscil said. The base’s cancer care center can perform stereotactic body radiation therapy, delivering precise doses of radiation.

This form of radiation therapy is effective for certain early-stage lung cancers, a modality not available at the Dayton VA.

“We are currently working to increase the number of VA patients undergoing SBRT at our facility,” Koroscil said. “We are very good at diagnosing and expediting therapy for cancer at Wright-Patterson Medical Center. I am very happy with our cancer care center, the oncologists and radiation oncologists.

“Talk about their hearts being in the care of vets! I think there is a different bond dealing with veterans and being in the services and having been deployed. I feel there is a mutual understanding between patient and physician.”

Future of military care

Wright-Patterson Medical Center has other resource-sharing agreements around the area, too. Emergency room doctors work at Miami Valley Hospital in Dayton, while there is a Soin Medical Center rotation in Beavercreek as well.

These partnership trends with other facilities are important for medical readiness and skill preservation so military medical teams are ready for deployment and wartime operations, 88th Medical Group officials say.

“We envision similar sharing platforms taking place across the nation in all medical specialties to maintain skills needed for deployment and to provide amazing care to our veterans,” Berglund said. “I have never felt more motivated and excited to come to work each day knowing that we have a clear mission to accomplish.”

Given the direction of military medicine, integrated models are the best option moving forward, Koroscil added.

“There is an appreciation higher up above me about what I did and what we have going at the VA because I think that is what’s going to be necessary in the future in terms of medical readiness and also deciding on what military facilities will continue and be kept open,” he said.

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