Healthcare Inspection – Inadequate Staffing and Poor Patient Flow in the Emergency Department, VA Maryland Health Care System, Baltimore, Maryland

The VA OIG evaluated allegations regarding staffing and poor patient flow in the Emergency Department (ED) at the VA Maryland Healthcare System, Baltimore, MD. A complainant alleged that patients were left unmonitored for extended periods of time and experienced prolonged ED stays due to severe bed and staff shortages. The complainant also described poor patient flow and problematic administrative processes. We substantiated that there were times when patients’ monitoring was interrupted due to lack of specialty (telemetry and isolation) beds; however, the facility had already initiated plans to expand specialized bed capacity. We also found there were staff shortages and that the facility did not have contingency plans for ED staffing in times of increased patient care demand. We found problems with patient flow from the ED to inpatient areas, and noted that data used by the facility to address flow issues was inaccurate. We made five recommendations to improve specialty bed access, contingency staffing, and processes for patient flow.