Healthcare Inspection – Mid-Level Provider Oversight, George E. Wahlen VA Medical Center, Salt Lake City, UT

The VA Office of Inspector General Office of Healthcare Inspections conducted an inspection to assess the merits of allegations concerning the quality of mid-level provider patient care in an Intensive Care Unit (ICU) and the failure of leadership to take action when complaints were reported at the George E. Wahlen VA Medical Center, Salt Lake City, UT. We substantiated that mid-level providers restarted a patient’s home medications without necessary adjustments; inappropriately administered hydralazine to a patient resulting in cardiogenic shock; and failed to timely notify attending physicians when a patient experienced prolonged bradycardia. We did not substantiate allegations that facility leadership failed to take any action regarding these complaints. We identified issues concerning Physician Assistant (PA) supervision and scope of practice reviews, lack of a process equivalent to credentialing and privileging of physicians for the PAs and nurse practitioners, and confusion regarding the reporting of adverse events. We recommended that the facility Director establishes a process for mid-level provider scope of practice reviews that is equivalent to the Focused Professional Practice Evaluations and Ongoing Professional Practice Evaluations processes; ensures that mid-level Professional Standards Boards forward their recommendations for the granting of scopes of practice to the Medical Executive Committee for review; provides adverse event reporting training for all ICU staff and attending physicians; and strengthens ICU near miss and adverse event reporting procedures.