Warrior transition units at 5: Are they the optimal model of care for wounded, ill and injured soldiers?

After the 2007 scandal surrounding patient living conditions at the former Walter Reed Army Medical Center, the Army hastily stood up warrior transition units (WTUs) to care for its wounded, ill, and injured. This sweeping response to a localized incident effectively established shadow, non-medical chains of command within most Army medical facilities by removing the daily administrative management of wounded, ill and injured soldiers from Army Medical Department (AMEDD) personnel. Over the last five years, this sprawling network has grown to include 29 WTUs on military installations and an additional 9 community-based WTUs primarily serving National Guard and Army Reserve personnel. Overall, WTUs now oversee the administrative support and case management of approximately 9,500 soldiers. Numerous media accounts and Inspector General reports suggest that the WTU model has not delivered its promised outcomes for patient case management and the coordination of care. Some observers suggest that the WTU “triad of care” (primary care manager, nurse case manager, and squad leader) creates an inherent tension in the clinical environment. The squad leaders and commanders of soldiers assigned to WTUs are non-medical personnel and despite their motivation and dedication to duty, many do not have the skill sets, attitudes or backgrounds to navigate the care environment of complex patient cases. The current budgetary environment may provide an opportunity to take a fresh look at the WTU concept and its performance. An objective analysis of costs, personnel requirements and patient outcomes might suggest that current WTU command and administrative functions could be best performed by AMEDD personnel as they were prior to 2007.