Healthcare Inspection: Review of Circumstances Leading to a Pause in Providing Inpatient Care, VA Northern Indiana Heathcare System, Fort Wayne, Indiana.

摘要

The VA Office of Inspector General Office of Healthcare Inspections conducted an inspection at the request of Senator Joe Donnelly and Congressman Marlin Stutzman regarding the suspension (pause) of all inpatient admissions at the Fort Wayne campus (the facility) of the VA Northern Indiana Healthcare System (VANIHCS), Fort Wayne, IN, in October 2012. The OIG was asked to review overall quality of care and management at the facility, define what issues led to suspension of inpatient care, and determine what measures need to be taken to return the facility to normal operations. We reviewed medical records and nursing administrative documents and identified issues with quality of inpatient care in multiple cases. Several factors likely contributed to the circumstances that allowed this to happen: the facility did not effectively and consistently fill upper and mid-level leadership positions, there were lapses in clinical judgment by individual providers, and there was limited compliance in maintaining nurse competencies. Managers that were in place often did not provide necessary leadership. Some prior budget deficits had been addressed, at least in part, by not filling key staff positions. As of May 2013, inpatient operations had not resumed at full capacity but are being phased in. We determined that the facility, Veterans Integrated Service Network (VISN) 11, and Veterans Health Administration (VHA) could have improved communication to stakeholders regarding the pause. In view of recurring qualitative issues relating to patient care, lack of long-term stability in upper and mid-level leadership positions, and workload, VISN 11 may need to consider the scope of services the facility is capable of reliably providing, namely, the appropriate designation for ICU level care in the near term and whether an ICU is viable in the long-term.