Healthcare Inspection: Inadequate Staffing and Poor Patient Flow in the Emergency Department VA Maryland Health Care System Baltimore, Maryland.

摘要

The VA Office of Inspector General Office of Healthcare Inspections evaluated the validity of allegations about the Emergency Department (ED) at the Baltimore VA Medical Center (facility), which is part of the VA Maryland Health Care System (system). A complainant alleged that because of severe shortages of beds and staff, patients had prolonged ED stays and were inappropriately left unmonitored for extended periods. The complainant also described poor patient flow and dysfunctional administrative processes. We substantiated that there were staff shortages and found that the facility did not have contingency plans for ED staffing during periods of increased demand for patient care. The facility did not have a diversion policy as required by VHA. We found problems with patient flow from the ED to inpatient areas, and noted that data used by the facility to address flow issues was inaccurate. We also found a shortage of specialty (telemetry and isolation) beds; however, the facility had already initiated plans to expand specialized bed capacity. Further, we found that poor communication and sub-optimal composition of the Patient-Flow Committee contributed to deficiencies in the delivery of care.