Healthcare Inspection: Emergency Department Delays Memphis VA Medical Center, Memphis, TN.

摘要

The VA Office of Inspector General Office of Healthcare Inspections received allegations from a complainant that census in the Emergency Department (ED) at the Memphis VA Medical Center, Memphis, TN, exceeds bed capacity on a regular basis, compromising patient safety. The Hotline Division of the Office of Inspector General initially referred this complaint to the Veterans Integrated Service Network (VISN) 9 for response. Because the VISNs response did not fully address the allegations, we initiated an inspection. The complainant specifically alleged that on August 1, 2011, conditions in the ED included patients on stretchers in the hallway, a shortage of telemetry beds, and excessive wait times. The complainant also alleged the following were conditions of a chronic nature: shortage of hospital beds; long waits for transfers from ED; insufficient number of telemetry beds in the ED; insufficient ED equipment and supplies; frequent management refusal to grant diversion; and management unresponsiveness to these conditions. We substantiated that on August 1, 2011, census in the ED exceeded capacity and some patients were in the ED as long as 14 hours awaiting admission or transfer. We did not substantiate that patients in need of cardiac monitoring were left unattended on stretchers in the hallway. We found that the facilitys sustained performance for ED length of stay (LOS) is far below the VHA standard. Many factors, including inappropriate ED visits, contributed to ED delays. With the exception of availability of ultrasound services, we found that ED resources were adequate. We were unable to substantiate that management had denied appropriate requests for diversion. We found that Emergency Department Integrated Software, and Veterans Health Information Systems and Technology Architecture data related to ED LOS times were unreliable. We substantiated that management was aware of these issues but had not taken adequate action for resolution. We reviewed 38 ED patients electronic health records and did not find that these patients experienced negative outcomes as a result of excessive ED LOS.