Intermediate Care Technician
Last updated
Share PrintThe Department of Veterans Affairs (VA) Intermediate Care Technician (ICT) Program is a program designed to hire former military corpsmen and combat medics into positions at VA Medical Centers as an integral part of the medical team. An ICT’s Scope of Care permits maximum utilization of the skills, abilities, and experience former corpsmen and medics have acquired during active duty. ICTs are located primarily in Emergency Departments; however, VA is now hiring ICTs in virtually every clinical setting that will benefit from ICT skill sets such as Primary Care, Specialty Clinics, and Surgical Services.
Origin:
January 2013, VA Northeast Ohio Healthcare System
Adoptions:
112 successful, 84 in-progress
Awards and Recognition:
VA Clinical Strong Practice , iNET Spread Investee
Partners:
Diffusion of Excellence, Emergency Medicine, Office of Primary Care, VHA Innovators Network, Workforce Management and Consulting
Recent Updates
Overview
The problem
The Veterans Health Administration (VHA) is committed to providing world-class Veteran experience through a Veteran-centered culture that strives to be a trusted enterprise where Veterans feel heard, honored, and valued within the organization. A reoccurring concern reported by Veterans is that the VHA is a complex, ever evolving system that can be difficult
...
The Veterans Health Administration (VHA) is committed to providing world-class Veteran experience through a Veteran-centered culture that strives to be a trusted enterprise where Veterans feel heard, honored, and valued within the organization. A reoccurring concern reported by Veterans is that the VHA is a complex, ever evolving system that can be difficult to understand and navigate. Additionally, an ongoing concern reported by Veterans is feeling disconnected from their VHA care team. With over 65% of the VA workforce never serving in the military, it can be challenging for Veterans to feel their health care team fully understands their needs and experience.
The Military occupational specialty (MOS) of combat medic, medical technician and corpsman is one of the largest job fields for active duty, guard, and reserves. The population of former military medics & corpsmen leaving the service is continuing to see an upward growth, with Enlisted DoD Allied Healthcare Separations increasing 60% just over the last three years. Currently 16,500 service members attend the DoD joint force (METC) training center in Fort Sam Houston annually where they gain the basic skills and knowledge to set into the role of “Doc” for all five branches of service. Annually a staggering 16,253 former military medics and corpsmen separate from Active Duty, National Guard, and Reserves with no clear civilian equivalent pathway to employment.
The VHA OIG Occupational Staffing Shortages report for FY 2018 showed 46 facilities with occupational shortages for 0620 Practical Nurse and 0621 Nursing Assistant positions. An additional 22 facilities had shortages for the 0640 Health Aid and Technician (title 5) occupational series. This highlights the significant staffing needs within the VHA. See more
The Military occupational specialty (MOS) of combat medic, medical technician and corpsman is one of the largest job fields for active duty, guard, and reserves. The population of former military medics & corpsmen leaving the service is continuing to see an upward growth, with Enlisted DoD Allied Healthcare Separations increasing 60% just over the last three years. Currently 16,500 service members attend the DoD joint force (METC) training center in Fort Sam Houston annually where they gain the basic skills and knowledge to set into the role of “Doc” for all five branches of service. Annually a staggering 16,253 former military medics and corpsmen separate from Active Duty, National Guard, and Reserves with no clear civilian equivalent pathway to employment.
The VHA OIG Occupational Staffing Shortages report for FY 2018 showed 46 facilities with occupational shortages for 0620 Practical Nurse and 0621 Nursing Assistant positions. An additional 22 facilities had shortages for the 0640 Health Aid and Technician (title 5) occupational series. This highlights the significant staffing needs within the VHA. See more
The solution
A solution to VHA’s staffing shortages and the need for former medic and corpsmen employment is the VHA Intermediate Care Technician (ICT). ICTs are former military medics and corpsmen that have a more advanced scope than a traditional VA Health Technician mirroring their military education, experience, and service. Additionally, Veterans are very familiar
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A solution to VHA’s staffing shortages and the need for former medic and corpsmen employment is the VHA Intermediate Care Technician (ICT). ICTs are former military medics and corpsmen that have a more advanced scope than a traditional VA Health Technician mirroring their military education, experience, and service. Additionally, Veterans are very familiar with military medics and corpsman and their scope of practice because most active duty personal have been treated by medics while in the service.
Thus, incorporating ICTs into interdisciplinary care teams increases opportunities for Veterans to be cared for by their fellow brothers and sisters in arms and bring a sense of familiarity and trust to their experience. Medical Centers that utilize the ICTs clinical skills, patient navigation and care coordination abilities, have found increase access to care, enhanced nursing and medicine productivity, and increased patient and caregiver satisfaction. See more
Thus, incorporating ICTs into interdisciplinary care teams increases opportunities for Veterans to be cared for by their fellow brothers and sisters in arms and bring a sense of familiarity and trust to their experience. Medical Centers that utilize the ICTs clinical skills, patient navigation and care coordination abilities, have found increase access to care, enhanced nursing and medicine productivity, and increased patient and caregiver satisfaction. See more
The results
When ICTs are adopted into a medical center’s ecosystem, in unique health care roles they have impactful interactions with patients, patient family members, and employees.
There are several tools which will be used to collect and track metric data.
The first is local ICT implementation data from VHA facilities who have reported their ICT Program experi ... When ICTs are adopted into a medical center’s ecosystem, in unique health care roles they have impactful interactions with patients, patient family members, and employees.
There are several tools which will be used to collect and track metric data.
The first is local ICT implementation data from VHA facilities who have reported their ICT Program experiences.
A Return on Investment (ROI) data analysis was just recently completed focused on the ICT role within Emergency Medicine which showed impactful positive data linking the ICT role to increase in access.
There are several facilities that are capturing the patient experiences by utilizing patient satisfaction surveys.
Secondary metrics utilized to capture growth and development of the program is the ICT dashboard which captures ICT Program data at the VISN and Facility level, including onboarding ICT sites and number of new hires. The applicant tracking system (ATS) was created to assist facilities in vetting applicants and target market ICT candidates. This allows us to estimate the number of individuals interested in ICT positions.
In 2016, a patient satisfaction survey was completed by the Louis Stokes Cleveland VA Medical Center in the Emergency Department where Veterans were asked, “Did having a Veteran as part of your care team in the VA Emergency Department improve your Emergency Room experience?” 84% of Veterans choose to “Strongly Agree.”
As part of an evaluation of the innovators network at the VA, a return on investment (ROI) analysis of the ICT role in Emergency Medicine was conducted to calculate the financial gains and losses while accounting for the resources invested into the ICT Program. In addition, the cost offsets of the ICT Program (from increased throughput, reduced costs) to the investment required was compared to control sites who had not implemented the role.
The ROI team examined six EDIS times as a proxy for utilization to measure the impact of having ICTs working in the ED. The six measures included Door to Doc, Door to Triage, Discharged Patient Length of Stay, Admitted Patient Length of Stay, Left Without Being Seen (LWBS), and Total Count (patient volume).
One example measure is “Door to Triage” time for intervention sites decreased 2.45 minutes after the implementing ICTs from 7.56 to 5.1, compared with 0.67 minutes from 10.18 to 9.52 in the control sites who did not have ICTs.
The VA Northeast Ohio Healthcare System found that when adding an ICT to the Physician in Triage (PIT) “Door to Doc” time for ESI level 3 patients had an average decrease in waiting time by 33 minutes. Measures also found that on average the “Seen and Discharge” length of stay decreased for PIT patients by 32 minutes.
The Louis Stokes Cleveland VA Emergency Department (ED) conducted an ICT patient satisfaction survey where 100% of Veterans polled who had an ICT as part of their care team in the ED found them to be professional and helpful.
The Louis Stokes Cleveland VA Medical Center (LSCVAMC) GERI-Vet (Geriatric Emergency Room Innovations for Veterans) program identifies vulnerable older adults in the ED and utilizes ICTs (Intermediate Care Technicians) as geriatric syndrome screeners and care coordinators. To date, the program has served 1300 Veterans and shows that ICTs can accurately screen for geriatric syndromes, such as dementia, delirium, functional decline, and fall risk.
Outcomes from this experience:
9.4% decrease in hospital admissions from the ED (16.2% relative reduction).
9.2% decrease in 30-day hospital admissions (14.2% relative reduction) compared to matched controls.
Decreased admissions by 9.4% for a cost savings of $3,057,900/year at LSCVAMC.
Cost saved per veteran served is $2,216, a 1100% return on investment.
ICTs within the John D. Dingel VA Medical Center in Detroit, Michigan have been trained and retain competencies to administer Battlefield Acupuncture (BFA) within the Emergency Department and Walk-In Pain Clinic to Veterans suffering from chronic pain. Adding innovative Whole Health practices like administering BFA to the ICTs scope have helped the facility reduce opiod prescribing by 49% in the Emergency Department. ICTs within the Detroit VA Medical Center have helped treat well over 250 Veteran patients since being trained in Battlefield Acupuncture. Dr. Bassam Batarse, Associate Chief of Staff and Service Chief for Integrated Clinical Services admires the ICTs discipline and dedication in helping to heal and serve Veterans in their time of need. See more
There are several tools which will be used to collect and track metric data.
The first is local ICT implementation data from VHA facilities who have reported their ICT Program experi ... When ICTs are adopted into a medical center’s ecosystem, in unique health care roles they have impactful interactions with patients, patient family members, and employees.
There are several tools which will be used to collect and track metric data.
The first is local ICT implementation data from VHA facilities who have reported their ICT Program experiences.
A Return on Investment (ROI) data analysis was just recently completed focused on the ICT role within Emergency Medicine which showed impactful positive data linking the ICT role to increase in access.
There are several facilities that are capturing the patient experiences by utilizing patient satisfaction surveys.
Secondary metrics utilized to capture growth and development of the program is the ICT dashboard which captures ICT Program data at the VISN and Facility level, including onboarding ICT sites and number of new hires. The applicant tracking system (ATS) was created to assist facilities in vetting applicants and target market ICT candidates. This allows us to estimate the number of individuals interested in ICT positions.
In 2016, a patient satisfaction survey was completed by the Louis Stokes Cleveland VA Medical Center in the Emergency Department where Veterans were asked, “Did having a Veteran as part of your care team in the VA Emergency Department improve your Emergency Room experience?” 84% of Veterans choose to “Strongly Agree.”
As part of an evaluation of the innovators network at the VA, a return on investment (ROI) analysis of the ICT role in Emergency Medicine was conducted to calculate the financial gains and losses while accounting for the resources invested into the ICT Program. In addition, the cost offsets of the ICT Program (from increased throughput, reduced costs) to the investment required was compared to control sites who had not implemented the role.
The ROI team examined six EDIS times as a proxy for utilization to measure the impact of having ICTs working in the ED. The six measures included Door to Doc, Door to Triage, Discharged Patient Length of Stay, Admitted Patient Length of Stay, Left Without Being Seen (LWBS), and Total Count (patient volume).
One example measure is “Door to Triage” time for intervention sites decreased 2.45 minutes after the implementing ICTs from 7.56 to 5.1, compared with 0.67 minutes from 10.18 to 9.52 in the control sites who did not have ICTs.
The VA Northeast Ohio Healthcare System found that when adding an ICT to the Physician in Triage (PIT) “Door to Doc” time for ESI level 3 patients had an average decrease in waiting time by 33 minutes. Measures also found that on average the “Seen and Discharge” length of stay decreased for PIT patients by 32 minutes.
The Louis Stokes Cleveland VA Emergency Department (ED) conducted an ICT patient satisfaction survey where 100% of Veterans polled who had an ICT as part of their care team in the ED found them to be professional and helpful.
The Louis Stokes Cleveland VA Medical Center (LSCVAMC) GERI-Vet (Geriatric Emergency Room Innovations for Veterans) program identifies vulnerable older adults in the ED and utilizes ICTs (Intermediate Care Technicians) as geriatric syndrome screeners and care coordinators. To date, the program has served 1300 Veterans and shows that ICTs can accurately screen for geriatric syndromes, such as dementia, delirium, functional decline, and fall risk.
Outcomes from this experience:
9.4% decrease in hospital admissions from the ED (16.2% relative reduction).
9.2% decrease in 30-day hospital admissions (14.2% relative reduction) compared to matched controls.
Decreased admissions by 9.4% for a cost savings of $3,057,900/year at LSCVAMC.
Cost saved per veteran served is $2,216, a 1100% return on investment.
ICTs within the John D. Dingel VA Medical Center in Detroit, Michigan have been trained and retain competencies to administer Battlefield Acupuncture (BFA) within the Emergency Department and Walk-In Pain Clinic to Veterans suffering from chronic pain. Adding innovative Whole Health practices like administering BFA to the ICTs scope have helped the facility reduce opiod prescribing by 49% in the Emergency Department. ICTs within the Detroit VA Medical Center have helped treat well over 250 Veteran patients since being trained in Battlefield Acupuncture. Dr. Bassam Batarse, Associate Chief of Staff and Service Chief for Integrated Clinical Services admires the ICTs discipline and dedication in helping to heal and serve Veterans in their time of need. See more
Files
- ICT Emergency Department Return on Investment ICT ROI Final Report
- Graphs from the ICT ED ROI ICT ROI Group Report
- This Journal article describes the VA innovative Intermediate Care Technician (ICT) Program utilizing quantitative and qualitative date looking through the lens of the World Health Organization (WHO) task-shifting module. Inconclusion the VHA ICT Program demonstrates to the U.S. Healthcare System a validated and reliable program to address healthcare worker shortages, reduce healthcare costs, increase access to care, and manage increasing demand for healthcare. The Return on federal Investments of Medics/Military Medicine
- Journal of Geriatric Emergency Medicine (JGEM) ICTs for Geriatric Emergency Department_ A Novel Workforce
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
Above:
ICT Leaders in Geriatric Emergency Medicine
Above:
ICT COVID Picture
Implementation
Departments
- Emergency care
- Critical care
- Telehealth
- Outpatient surgery
- Primary care
- Urgent care
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
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Links
- ICT SharePoint Site Link ICT SharePoint
- VA ICT Clinical Strong Practice (CSP) COVID Link VA ICT CSP
- ICT G.I. Jobs Magazine Article Link G.I. Jobs Magazine
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email VHA11PCPrimaryCareAction@va.gov with questions about this innovation.
About
Origin story
In December 2012, a 13-month pilot program was launched at 15 VA medical facilities that introduced a new role, the Intermediate Care Technician (ICT) in the Emergency Department. The goal of the ICT Pilot Program was to recruit former military medics and corpsmen into positions in VA Emergency Departments with a scope of practice more advanced than a tradi
...
In December 2012, a 13-month pilot program was launched at 15 VA medical facilities that introduced a new role, the Intermediate Care Technician (ICT) in the Emergency Department. The goal of the ICT Pilot Program was to recruit former military medics and corpsmen into positions in VA Emergency Departments with a scope of practice more advanced than a traditional VA ED Health Technician. The role was proposed to provide a high level of clinical support to both nursing and medicine and to more effectively utilize the skills of former military medics and corpsmen for Veteran care. An ICT position description (PD) was developed and classified at the level of a GS-6 and a GS-7 depending on the scope of practice.
After the pilot, the 15-facilities overwhelming supported the expansion of the ICT role to other clinical settings. In addition, 33 non-pilot facilities expressed an interest in hiring ICTs for 36 additional clinical areas. Post-pilot recommendations included VHA-wide expansion of the ICT role as a specialty classification for all care settings; the creation of a national ICT Program Manager under the Office of Nursing Service to provide consultation and oversight for the implementation and utilization of the role; and that ICT clinical experiences are designed to serve as a portal or pathway for VA career opportunities as professional licensed clinicians.
Original team
Kristina Snell
ICT National Program Lead, OPC, VHA
Scott Pawlikowski, MD
Director, Improvement and Innovation, OPC, VHA
i would like to see how I can get this implemented here in our SCI Program, particularly in Telehealth at our site. thank you.
Thank you for your question.. we can absolutely discuss. I will send you an email.
Very interested in learning more about this position - is there any sort of crosswalk or comparison of skill sets/proficiencies required for ICTs vs LPNs or other clinicians?
This comment has been deleted.
Yes, our VA SharePoint houses all scopes of care for our ICTs. I will send you an email.
looking for guidance to start this program at local clinic, washington state
I will send you an email with all the information. Thank you for your comment.
Does anyone have example performance standards for annual proficiencies?
Hello Nurse Manager Tierney! thank you for your inquiry. I have sent you an email with the materials you requested.