Care in the Community Consult Management During the COVID-19 Pandemic at the Martinsburg VA Medical Center in West Virginia

The VA Office of Inspector General (OIG) conducted a healthcare inspection at the Martinsburg VA Medical Center (facility) in West Virginia to assess allegations of failure to schedule a Care in the Community (CITC) COVID Priority 1 cardiology consult within Veterans Health Administration requirements, and delays in CITC consult scheduling caused by inadequate CITC staffing. The OIG substantiated that a COVID Priority 1 CITC cardiology consult was not scheduled within 30 days of the clinically indicated date. The OIG determined that the consult was amongst a backlog of approximately 5,000 various specialty CITC consults that were unscheduled. Additionally, facility CITC staff failed to create action plans to improve failed metrics; maximize use of available reports to manage consults; conduct clinical reviews of unscheduled consults; and develop a process to review potential adverse events occurring because of delayed consults. The OIG also learned that confusion surrounding priority and urgency status categories resulted in workarounds by other departments to avoid further delays in patient care. The OIG substantiated that inadequate staffing within the facility’s CITC Service caused delays in the scheduling of CITC consults. Contributing factors included reports of frequent staff turnover, outdated local CITC processes and lack of training, staff absences, and lack of alternative work options during the COVID-19 pandemic. The OIG made one recommendation to the Veterans Integrated Service Network Director related to monitoring the facility’s CITC Improvement Action Plans, progress, timelines, and next steps. The OIG made seven recommendations to the Facility Director related to CITC Improvement Action Plans, COVID Priority 1 report reviews, implementation of a clinical review process for unscheduled COVID Priority 1 consults and consults in which the patient died prior to being scheduled, evaluation of backlog management strategies, review of appointment scheduling occurring in departments outside CITC, and ensuring adequate CITC staffing levels.