Healthcare Inspection Alleged Quality of Care Issues in the Geriatrics and Extended Care Service VA North Texas Health Care System Dallas, Texas

The purpose of this review was to determine the validity of allegations regarding quality of care issues in Geriatrics and Extended Care Service. We substantiated that a diagnosis of a coronary artery bypass graft was inaccurately documented in a patient’s history and physical and that a physician recommended removal of a patient’s cognitive impairment diagnosis based on a brief cognitive exam. However, neither of these occurrences adversely affected patient care. We did not substantiate the allegations that: (a) a physician providing weekend coverage failed to evaluate a very ill patient who later developed cardiac tamponade, (b) home based primary care providers failed to diagnose two patients with hypercalcemia and/or vitamin D deficiency, (c) a physician had poor understanding of deep vein thrombosis prophylaxis, (d) a patient’s pain was poorly managed, and (e) Geriatric Extended Care Service failed to perform and monitor quality improvement activities. We made no recommendations.