Healthcare Inspection - Review of Circumstances Leading to a Pause in Providing Inpatient Care, VA Northern Indiana Healthcare System, Fort Wayne, Indiana

The VA OIG conducted an inspection at the request of Senator Joe Donnelly and Congressman Marlin Stutzman regarding the suspension (pause) of all inpatient admissions at the Fort Wayne campus (facility) of the VA Northern Indiana Healthcare System in October 2012. The OIG was asked to review overall quality of care and management at the facility, define what issues led to suspension of inpatient care, and determine what measures need to be taken to return the facility to normal operations. As of May 2013, inpatient operations had not resumed at full capacity but were being phased in. We determined that the facility, VISN 11, and VHA could have improved communication to stakeholders regarding the pause. In view of recurring qualitative issues relating to patient care, lack of long-term stability in upper and mid-level leadership positions, and workload, VISN 11 may need to consider the scope of services the facility is capable of reliably providing, namely, the appropriate designation for ICU level care in the near term and whether an ICU is viable in the long-term. We recommended that VHA develop policy and guidance for facilities when major clinical services are paused; that the VISN Director ensure the assigned ICU level of care is commensurate with facility capabilities, and that the facility Director ensure that recruitment efforts continue for vacant leadership positions, that nurse competencies are consistently completed and validated, and that the nurse staffing methodology is fully implemented. The Under Secretary for Health and VISN and facility Directors concurred with the inspection results. We will follow up on the planned actions until they are completed.