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5.4. Admission of Veterans with SCI/D
- The Chief, SCI Service, or designee, is responsible for the admission of eligible Veterans with SCI/D. Admissions must be predicated on mission, scope of services, evaluation, and/or determination of diagnostic etiology (see pars. 8, 9, and 10), and the medical and functional requirements of the patient. SCI/D designated beds are captured under bed section 22 for location and treating specialty purposes. NOTE: Non-SCI utilization criteria are not to be used.
- It is the responsibility of the VA medical center first contacted for admission to proceed with arrangements for transferring the Veteran to the nearest appropriate SCI Center. When the first VA medical center contacted does not have an SCI Center, arrangements must be made by the contacted VA medical center to transfer the patient directly to an accepting SCI Center. Admission to the local VA medical center may take place, but it is not a prerequisite for coordinating arrangements for the Veteran's admission to the SCI Center.
- The SCI Coordinator, or referring physician, must provide a patient history and physical examination note, pertinent progress notes, and physician interim or discharge summary for review by the SCI Center considering the patient for transfer. An electronic consultation should be sent to document, request, and track the request for transfer.
- Agreement on the transfer or admission date must be coordinated by the SCI admitting physician and referring SCI/D Support Clinic or SCI/D PCT Coordinator, or by the SCI admitting physician and the community provider. NOTE: The logistics and timing of the transfer are assessed based upon physician-to-physician contact.
- Activation of available SCI beds not currently staffed will be facilitated to accommodate admissions if the census and referrals to the SCI Center exceed the required staffed bed numbers. If an eligible Veteran with SCI/D from the catchment area is in need of acute or sustaining SCI/D care and cannot be accepted for admission at the SCI Center to which the Veteran is normally referred, the Chief of that SCI Center is responsible for:
- Making arrangements for care at another SCI Center;
- Communicating these arrangements to the patient or the patient's representative;
- Consultation with the patient's attending physician during the interim; and
- Tracking delays in admissions using a waiting list of pending admissions.
- Although a Veteran may apply to any SCI Center, emphasis is placed upon addressing the Veteran's needs in the SCI catchment area. However, in the interests of preserving continuity of care and respecting Veteran preference, Veterans with an existing relationship and treatment history at an SCI Center outside the designated catchment area will continue to receive care at that medical center. However, travel benefits are only to the nearest SCI Center. NOTE: Other factors are considered in addressing the needs of SCI/D applicants, such as the urgency of the patient's medical need, the availability of resources, eligibility, and entitlement priorities.
- Veterans with acute onset SCI/D are transferred immediately to an SCI Center. Veterans with SCI/D admitted to any VA medical center are to be transferred to the SCI Center in 72 hours for acute medical and/or surgical conditions and non-self-limiting conditions. The SCI Coordinator at facilities without an SCI Center must communicate with the SCI Chief as frequently as the patient's status indicates. Such patients with acute care needs must be evaluated as needed on a daily basis by personnel from the SCI/D Support Clinic or SCI/D PCT.
- Veterans with acute care issues in a VA medical center with an SCI Center are admitted directly to the SCI Center unless the Chief, SCI Service, approves admission to an alternate unit. Patients are to be located on the SCI unit, unless there is a need for an intensive care unit, nursing home care unit, or an exceptional clinical circumstance (which must be approved by the Chief, SCI Service). Any Veteran with SCI/D not on the SCI unit must be evaluated on a daily basis, as needed, as needed, by an SCI physician and SCI nurse; they must document the assessment and clinical recommendations.
- The special needs of female Veterans with SCI/D must be met through provisions for privacy (private rooms or shared with other females), appropriate supplies, apparel, and access to appropriate health care services as outlined by the Women Veterans Health Strategic Health Care Group. The designated SCI primary care providers provide or arrange for timely women's health care and gender specific screenings during the Veteran's comprehensive evaluation. When the SCI primary care provider or Veteran chooses to have these screenings done by Women's Health Care, pre-arrangements for this care during the annual evaluation (or when issues arise) will be made with Women's Health Care or by arrangements with Women's Health Care to provide the services in the SCI/D examination rooms, or through fee basis to an appropriately-trained provider with accessible health care office space and equipment.
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