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For the past nine months, experts from Walter Reed Army Medical Center (WRAMC) and National Naval Medical Center (NNMC) have been hard at work developing an intricate movement plan to transfer WRAMC inpatients to NNMC.

NNMC and WRAMC conducted an Inpatient Movement Rehearsal Exercise (MRX) early Sunday morning, designed to test all the aspects of the WRAMC-NNMC inpatient move plan which will take place at the end of August.

During the exercise, 18 simulated patients were transferred from WRAMC to NNMC via ambulance, aiming to test and evaluate every aspect of the plan which will eventually move anywhere between 75 to 150 inpatients.

"We planned this move right down to the very small details," said Col. Van Coots, Walter Reed Health Care System and WRAMC commander. "This really gave us the opportunity to really flesh out those details. We're a military organization and this is what military organizations do ... I always say this is not something no one has ever done before, certainly other hospitals have moved."

NNMC patient move director, Chris Gillette, explained the exercise actually started the Monday prior to the June 12 event, with WRAMC nurses meeting with NNMC nurses daily to understand the complexity and diagnosis of the Walter Reed patients and decide which ward would ultimately be their destination upon arrival.

Gillette explained the planners were looking at four distinct areas during the MRX: patient sending operations from WRAMC; receiving patients at NNMC; evaluating designated move routes to ensure safe and efficient transport; and looking at the wards as to how the nurses received those patients.

"We have no doubt we can move the patients, it's just really refining the process, ensuring everyone is aware," he said.

"I think this is the most monumental move in the history of the military health system," Coots added. "You are combining the flagship of Navy medicine and the flagship of Army medicine together, under the name of Walter Reed which is a brand name, a name known around the world and it stands for excellence in military medicine. So when you put this all together, I like to say you're creating the biggest and baddest military medical center in the world."

The entire move of staff will begin in August and will take the entire month, culminating with the inpatient move, explained Capt. David Bitonti, chief of staff for Integration and Transition, NNMC.

Although the MRX began at 4 a.m., the actual inpatient move day is set to start at 2 a.m. in a "very well-scripted plan" that also will officially close WRAMC. Coots will give a statement and prayer over the loudspeakers to the entire organization signaling the start of the patient transports. Well over 500 people will be involved in the move not including the health care providers already at NNMC along with county and District assets.

"We have different clinical and administrative processes we are trying to synchronize and align, so this is a huge team effort, [including] not only Walter Reed Army Medical Center, but Joint Task Force-National Capital Region, Naval Support Activity-Bethesda, and county and District police officers," Gillette said.

Three routes were identified for moving the patients with the shortest being 5.4 miles, or an estimated 10 to 15-minute ride.

"We're testing all three routes. They're all good routes," Gillette said.

A transport team will meet with each inpatient ahead of time so they know where they will be going based on the level of acuity they have relative to their illness. They will be staged accordingly and have the proper monitoring while being loaded onto ambulances outside of WRAMC's second floor lobby, Bitonti explained. The ambulance will then transport the patient from WRAMC to one of two staging areas at NNMC based on the condition of the patient.

"As they enter, they will be greeted, they will be logged into the hospital as a new inpatient and then they will be transported to the ward which will be their ultimate home," Bitonti said.

The ambulance will then be prepped and readied for another pick-up at WRAMC.

"At the end of the day there will be a final ceremony [at WRAMC], we will bring down the colors and Walter Reed will officially cease to be a hospital," Coots said. "That will be the first day of the Walter Reed National Military Medical Center."

He went on to explain that two-thirds of the 5,000 staffers he currently leads will make the move to Bethesda with the rest heading to Ft. Belvoir Community Hospital in Virginia.

"We took a good look across the board to make sure we have the right staff for the right clinical operations," he said.

"It's a very exciting time not only for military medicine, but medicine in general," Bitonti said. "The undertaking we have here, culminating at the end of August, is going to give the most deserving patients the best world-class care that they could possibly receive. We're very much looking forward to it and excited about the opportunity."