Healthcare Inspection - Surgeon Privileging and Resident Supervision Issues W.G. (Bill) Hefner VA Medical Center Salisbury, North Carolina

The VA Office of Inspector General, Office of Healthcare Inspections conducted an inspection to determine the validity of allegations of surgeon privileging and resident supervision issues at the W. G. (Bill) Hefner VA Medical Center (the facility), Salisbury, North Carolina. The complainant made the following allegations: Surgeons at the facility were performing operations that they did not have the clinical privileges to perform, which resulted in poor surgical outcomes. Residents were not supervised appropriately. We substantiated the allegation that some surgeons performed certain operative procedures without the appropriate corresponding privileges; however, we did not find evidence that poor surgical outcomes resulted. We substantiated the allegation that residents in Surgical Service were not supervised as required by VHA policy. We found that there was no surgeon on site 2 days per week while residents were seeing patients in the Clinic. Local policy did not define timeframes for the documentation of resident supervision as required by VHA. We also found that resident authored progress notes were not consistently co-signed by a supervising surgeon in the timeframe verbalized as acceptable by clinical leadership. VHA policy requires an “interval note” be entered into the medical record by a physician immediately prior to operative procedures. This note documents that the information in the previous progress notes was still accurate, an appropriate assessment was completed prior to surgery, the patient still required the procedure, and that the patient’s condition had not changed. We found that interval notes were not consistently entered into the medical record by the attending surgeon. We recommended that the Medical Center Director ensure that surgeons have current privileges for the procedures they perform and that Surgical Service residents have supervision onsite in accordance with VHA policy. We also recommended that the facility resident supervision policy define timeframes for the documentation of resident supervision and that pre-operative documentation be completed as required by VHA policy. The Veterans Integrated Service Network and Medical Center Directors concurred with our findings and recommendations and provided acceptable action plans.