I work at a small rural hospital in Montana. Scheduling follow-up care-especially from the ED-for patients who need orthopedic, oncologic, and other specialized services is frustrating. I often spend a significant part of each shift making these arrangements.

Further exacerbating the problem is the fact that patients often have to travel significant distances for this specialized care. The population at greatest risk for falling through the cracks is our veterans. It's challenging to cut through the red tape and arrange follow-up care for them at the "correct" Veterans Affairs (VA) hospital or clinic. Surgical cases, for instance, need to be transferred to Billings or Helena; veterans with psychiatric problems are transferred out of state to Sheridan, Wyoming.

The lack of clear guidance regarding referrals significantly increases wait times for veterans. We need to provide these services locally instead of sending patients to distant VA facilities.

Deborah Stein, BSN, RN

Lewistown, MT