This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the care provided at the Mann-Grandstaff VA Medical Center in Spokane, Washington. This evaluation focused on five key operational areas:
• Leadership and organizational risks
• Quality, safety, and value
• Medical staff privileging
• Environment of care
• Mental health (focusing on suicide prevention initiatives)
The OIG issued six recommendations for improvement in three areas:
1. Quality, safety, and value
• Peer Review Committee summary analysis data
• Executive-level medical committee review
2. Environment of care
• Safe work practices
• Clean and sterile storeroom access
3. Mental health
• Suicide-related event reporting
• Completion of Comprehensive Suicide Risk Evaluations
Open
Closed-Implemented
Closed-Not ImplementedThe Medical Center Director ensures the Peer Review Committee submits accurate peer review summary analysis data quarterly to the Health Care Delivery Council.
The Medical Center Director ensures the Health Care Delivery Council reviews the Peer Review Committee’s summary analysis quarterly and determines actionable items.
The Medical Center Director ensures employees comply with safe work practices to eliminate or minimize exposure to potentially infectious materials.
The Medical Center Director ensures the Inpatient Unit Nurse Manager for the medical/surgical intensive care unit restricts access to clean and sterile storerooms to authorized personnel.
The Medical Center Director ensures the Suicide Prevention Coordinator reports suicide-related events monthly to local mental health leaders and quality management staff.
The Medical Center Director ensures providers complete Comprehensive Suicide Risk Evaluations following patients’ positive suicide risk screens.