Deficiencies in Echocardiogram Interpretation Timeliness, Facility Policies, Patient Safety Reporting, and Oversight at the Fayetteville VA Coastal Health Care System in North Carolina

The VA Office of Inspector General (OIG) assessed an allegation and reviewed processes related to admission and treatment of patients who needed services that were unavailable at the Fayetteville VA Coastal Health Care System (facility). The OIG did not substantiate that the chief of medicine forced a hospitalist to admit a patient who needed services that were unavailable at the facility. The facility had limited inpatient cardiology and surgical services available; however, patients with needs that exceeded the facility’s capabilities were transferred to another facility. Although hospitalists reported concerns about providing medical coverage for inpatient and outpatient services, the coverage responsibilities were not outside the scope of hospitalists’ duties outlined in policy. Peers completed peer reviews and the OIG did not find evidence that peer reviews resulted in punitive actions. The OIG identified the following deficiencies: • Inpatient echocardiogram interpretations were delayed; however, no adverse events were identified. • An intensive care unit (ICU) policy and procedure permitted admission of patients requiring Continuous Renal Replacement Therapy, although the facility did not have resources to support the treatment. • Hospitalists’ failed to use the patient safety event reporting system, which may have impeded evaluation of potential system-wide issues. • Veterans Health Administration’s privileging policy was not followed to ensure that an intensivist was granted ICU privileges. • Professional practices evaluations were not completed for intensivists. The OIG made one recommendation to the Veterans Integrated Service Network Director related to privileging processes and five recommendations to the Facility Director related to echocardiogram interpretation, ICU procedure and policy, staff education on hospitalist coverage, patient safety reporting, and professional practice evaluations.