Healthcare Facility Inspection of the Sheridan VA Health Care System in Wyoming

Report Information

Issue Date
Report Number
24-00615-163
VISN
19
State
Wyoming
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Healthcare Facility Inspection
Report Topic
Patient Safety
Major Management Challenges
Healthcare Services
Recommendations
3
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary

This Office of Inspector General (OIG) Healthcare Facility Inspection program report describes the results of a focused evaluation of the care provided at the Sheridan VA Health Care System in Wyoming. 

This evaluation focused on five key content domains:
     •    Culture
     •    Environment of care
     •    Patient safety
     •    Primary care
     •    Veteran-centered safety net

The OIG issued three recommendations for improvement in two domains:
  1.    Environment of care
     •    Facility navigation tools for sensory-impaired veterans
  2.    Patient safety
     •    Patient test result communication effectiveness
     •    Service-specific workflows for test result communications

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The OIG recommends facility leaders implement tools to help sensory-impaired veterans navigate the facility.

No. 2
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The OIG recommends facility leaders ensure the facility has a policy for test result communication that includes methods to monitor the effectiveness of the patient notification process.

No. 3
Open Recommendation Image, Square
to Veterans Health Administration (VHA)

The OIG recommends facility leaders ensure staff develop workflows for the communication of test results for each service.