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RAVEE: Reaching All Veterans @ Every Encounter

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VHA should be utilizing this model of care, where everyone can RAVEE. To RAVEE is to Reach All Veterans @ Every Encounter and connect Veterans with the services they need. Every Veteran suicide prevented is something that VHA should rave about. There is no wrong door for identification of suicide risk; it is everyone's business.

This innovation is emerging and worth watching as it is being assessed in early implementations. See more emerging innovations.

Adoptions:

1 successful

Awards and Recognition:

National HeRO Award

Partners:

Audiology and Speech, Clinical Services, Mental Health and Suicide Prevention, Office of Health Informatics, Office of Primary Care, Optometry, Physical Medicine and Rehabilitation, Systems Redesign and Improvement

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Tags:

Access to Care Cardiology Community Care Continuity of Care Data and Analytics Dentistry Dermatology Emergency Care Geriatric Health Healthcare Administration
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Overview

Problem

Veterans may only receive care in one area of the healthcare system, limiting the opportunity to prevent suicide and connect those who screen positive to the quickest and best care. Most suicide prevention screens occur in mental health clinics, but about 50% of Veterans who complete suicide in VISN2 do not have a substance abuse or mental health diagnosis. ... See more

Images

Pareto chart showing percent of Missed Opportunities to Screen for Suicide Using the C-SSRS in FY22.

The above pareto chart indicates the number of missed screens (Y-axis) in each service (X-axis). It was identified that in FY22, Primary Care, Medicine and Specialty Care, Optometry and Audiology represented 54.6% of missed screens. This proved that we needed to target every encounter.

Solution

Each unique encounter creates a vital opportunity for suicide screening and connection to appropriate services. By utilizing an interdisciplinary approach that partners primary, specialty, and mental health care teams, the silo between disciplines is broken. In-service sessions included how to identify Veterans due for screening, how to resolve clini ... See more

Videos

Dr. Weyand, Chief of Optometry explains the why and how of RAVEE

Results

Nationally the C-SSRS clinic level data shows a completion rate by encounter around 61% for the week of September 7th, 2023. Facilities that have implemented the RAVEE practice increased annual suicide screening from 55% to consistently achieving between 80% and 90% completion rates by encounter. RAVEE helps to achieve VHA Priority to Action (P2A) goals by ... See more

Metrics

  • Suicide screening for Veterans increased an additional 9,000 encounters annually. An estimated 0.6% of veterans will screen positive, requiring additional follow up care. Utilizing RAVEE and partnerships with PCMHI, facilities can reach more veterans that would have otherwise walked out the doors.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

NY: Canandaigua VA Medical Center (Canandaigua)

There are no in-progress adoptions for this innovation.

There are no unsuccessful adoptions for this innovation.

Multimedia

Images

A spreadsheet depicting VA Finger Lakes key metric improvements with the implantation of RAVEE.

VA Finger Lakes Healthcare System and Audiology Clinic ROI with RAVEE

Implementation

Timeline

  • Two to Four Weeks
    Identify implementation team members and develop RAVEE implementation plan
  • One Month
    Communicate the implementation plan and expectations to clinical chiefs and employees utilizing Safety Forums, Process Improvement Forums, Leadership Rounding, Team Huddles, and Service Level Meetings.
  • One Month
    Provide training on Suicide Screening for all clinical staff and peer to peer mentoring. Implement standard work in all clinics including a resource sheet with contacts for completing a warm hand off when indicated.
  • One Month
    Monitor and share real-time data back to clinical teams.

Departments

  • Mental health care
  • Social work
  • Audiology and speech
  • Dermatology
  • Emergency care
  • Pharmacy
  • Cardiology
  • Cardiology
  • Geriatrics
  • Dental/oral surgery
  • Adaptive sports
  • Hospital medicine
  • Nursing services
  • Internal medicine
  • Military sexual trauma
  • Optometry
  • Orthopedics
  • Pain management
  • Physical medicine and rehabilitation
  • Primary care
  • Pulmonary medicine
  • Suicide prevention
  • Urgent care
  • Urology
  • Whole health
  • Women Veteran care
  • Wound care and ostomy
  • Neurology
  • Nutrition, food, and dietary

Core Resources

Resource type Resource description
PEOPLE
  • Chief of Staff
  • Clinical Service Chief
  • Suicide Prevention Coordinator
  • PCMHI Coordinator
PROCESSES
  • Safety Forums
  • Process Improvement Forums
  • Leadership Rounding
  • Team Huddles
  • Service Level Meetings
TOOLS
  • Suicide Screening Standard of Work
  • Contact List of Suicide Prevention Resources

Optional Resources

Resource type Resource description
PEOPLE
  • Change Management Practitioner
  • Systems Redesign Coordinator

Risks and mitigations

Risk Mitigation
Concern about cost Leveraged current staffing by utilizing subject matter experts in suicide prevention to conduct trainings and peer to peer mentoring sessions (no cost).
Provider Discomfort Peer to peer mentoring, sharing of best practices, role playing, scripting, and sharing success stories empowered providers to conduct screening.
Lack of Sustainment Daily clinical huddles are held to monitor the outcome of this innovation. Suicide prevention screening metrics are presented daily on the enterprise wide visual dashboard and executive leadership meetings, following the pillars of a High Reliability Organization (HRO). Sustainment efforts are implemented when identified through these means.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

VA User (Medical Technologist) posted

I believe another useful resource is the clinical laboratory. When a Veteran presents for a blood draw, we spend 5-10 minutes with each Veteran face-to-face and in a private setting. Often the Veterans tell us their stories, including how they have been struggling. In such an intimate setting, my coworkers and I have been the first person that the Veteran felt comfortable enough to speak to, and we've often contacted Veteran Teams to intervene when a Veteran admits they were thinking of suicide.

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About

Origin story

VA Finger Lakes Healthcare System identified suicide screening as a strategic performance improvement priority; suicide personally resonates with Veterans, families and employees alike in some way. Out of a survey of 1,700 adult respondents it was determined that nearly half (46.7%) knew someone who had died by suicide (Cerel et al., 2018), constituting a su ... VA Finger Lakes Healthcare System identified suicide screening as a strategic performance improvement priority; suicide personally resonates with Veterans, families and employees alike in some way. Out of a survey of 1,700 adult respondents it was determined that nearly half (46.7%) knew someone who had died by suicide (Cerel et al., 2018), constituting a suicide exposure during their lifetime. By committing to improving suicide screening across the continuum of care, Finger Lakes increased the percentage of annual suicide screens completed and reduced harm.

Search tags

Access to Care Cardiology Community Care Continuity of Care Data and Analytics Dentistry Dermatology Emergency Care Geriatric Health Healthcare Administration