Community Based Outpatient Clinic Reviews: Framingham, MA; Charlottesville, VA; Jennings and Lafayette, LA; Bridgeport (Decatur) and Sherman, TX; Caldwell and Twin Falls, ID

The VA Office of Inspector General reviewed eight Community Based Outpatient Clinics (CBOCs) the week of October 18, 2010. CBOCs were reviewed in Veterans Integrated Service Network (VISN) 1 at Framingham, MA; in VISN 6 at Charlottesville, VA; in VISN 16 at Jennings and Lafayette, LA; in VISN 17 at Bridgeport (Decatur) and Sherman, TX; and, in VISN 20 at Caldwell and Twin Falls, ID. The parent facilities of these CBOCs are VA Boston Health Care System (HCS), Hunter Holmes McGuire (Richmond) VA Medical Center (VAMC), Alexandria VAMC, VA North Texas HCS, and Boise VAMC, respectively. The purpose of the review was to assess whether CBOCs are operated in a manner that provides veterans with consistent, safe, high-quality health care. The review covered five areas: quality of care measures, credentialing and privileging, environment of care and emergency management, management of laboratory results, and CBOC contracts. We noted opportunities for improvement and made the following recommendations to VISN and facility managers: VA Boston HCS: Require sufficient documentation of data in the Professional Standards Board (PSB) meeting minutes to support privileging and reprivileging for providers at the Framingham CBOC. Richmond VAMC: Ensure modifications are made to the entrance doors to improve access for disabled veterans at the Charlottesville CBOC. Alexandria VAMC: Require that PSB grant clinical privileges based on the type of care and services performed or provided at the Jennings and Lafayette CBOCs. Collect and monitor measurable data for hand hygiene at the Lafayette CBOC. Ensure the Behavior Health campus clinic at the Jennings CBOC has an automated external defibrillator onsite. VA North Texas HCS: Require that critical laboratory test results be given to the ordering provider within the timeframe established in facility policy at the Decatur CBOC. Ensure the ordering provider documents patient notification and treatment actions in response to critical results at the Decatur CBOC. Require that normal test results be consistently communicated to patients within the specified timeframes at the Decatur CBOC. Require access be improved for patients in need of assistance at the Decatur CBOC. Require auditory privacy be maintained during the check-in process at the Decatur CBOC. Boise VAMC: Grant clinical privileges that are consistent with the practices at the Twin Falls CBOC. Ensure the Boise VAMC Executive Committee meeting minutes include documentation that reflects the rationale for granting privileges. Require that ordering providers at the Twin Falls CBOC document patient notification and treatment actions in response to critical results. Ensure ordering providers at the CBOCs document patient notification of diagnostic test results. Properly secure sharps and solutions at the Twin Falls CBOC. Ensure the Chief of Office of Information and Technology evaluates the use of the Informational Technology closet at the Twin Falls CBOC and implements appropriate measures according to VA Handbook 6500.