A VAIG REPORT: Healthcare Inspection Dermatology Clinic Staffing and Other Concerns (2012-2014)



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06/28/2017 08:00 PM EDT

OIG conducted a Combined Assessment Program (CAP) review at the Dayton VA Medical Center (facility), Dayton, OH, during the week of February 2, 2015. Prior to the site visit, OIG deployed an electronic employee survey regarding patient safety and quality of care known as the Employee Assessment Review (EAR). An EAR respondent reported that during Quarters (Q) 3 and 4, fiscal year (FY) 2012, and FYs 2013 and 2014: a) Patient Business Service (PBS) schedulers assigned on a temporary basis to cover the Dermatology Clinic were not adequately trained in its specific scheduling practices; therefore, appointments were not consistently scheduled in accordance with preferred dates. b) PBS schedulers did not return calls to patients in a timely manner; (c) As a result, Dermatology appointments were not scheduled timely; (d) One of 20 patients with scheduling delays had a clinically significant adverse outcome as a result. OIG's goal is to conduct inspections, report on conditions, and provide information that is timely and useful for agency managers and other stakeholders. In this case, the deficient conditions dated back several years and had since been corrected by facility managers. We therefore summarized the allegations, described the conditions that existed at the time of the allegations, and outlined the sequence of events in FYs 2012–2014 focusing on facility corrective actions. OIG also performed a look-back of patients diagnosed with new melanomas or other skin cancers from FY 2013 through Q3 FY 2016 and provided a status of Dermatology Clinic-related operations as of Q4 FY 2016. In 2012, the Dermatology Clinic lost its permanently assigned PBS scheduler. PBS schedulers had to cover the Dermatology Clinic and other specialty care clinics during FYs 2012–2014 (and in Qs 1 and 2 FY 2015). The Chief of Dermatology Service regularly reported the staffing challenges to leadership. Documentation showed that clinical and administrative managers attempted to work together to improve clinic access and timeliness. While we substantiated specific instances of inadequate scheduling practices, poor follow-up to patient telephone calls, and delayed appointments during the time that PBS schedulers covered the Dermatology Clinic, we did not substantiate systemic deficiencies in those areas. While we substantiated scheduling delays, we did not substantiate patients experienced clinically significant adverse outcomes in the cases provided by the survey respondent or in our look-back of patients diagnosed with new melanomas or other skin cancers FY 2013–Q3 FY 2016. We made no recommendations.

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