Healthcare Inspection – Emergency Department Staffing and Patient Safety Issues, VA San Diego Healthcare System, San Diego, California

OIG conducted an inspection in response to allegations concerning critically low registered nurse (RN) staffing levels and patient safety issues in the Emergency Department (ED) at the VA San Diego Healthcare System (system), San Diego, CA. We substantiated that three RNs were on shift after midnight. In June 2013, the ED included an additional full-time RN on the midnight shift to cover for RN call-ins. We substantiated the allegation that the system did not have an emergency plan or policy that addressed low RN staffing levels in the ED. However, the Veterans Health Administration does not require a system policy that specifically addresses low RN staffing levels in the ED, but does require that facilities have a plan for additional RNs, providers, and support staff in times of acute overload or disaster. The ED did not have a plan for additional staff in times of acute overload or disaster. We did not substantiate that RNs who floated to the ED were not oriented to the floor. However, some RNs reported inadequate orientation at the time of the float. We did not substantiate that numerous Patient Event Reports (PERs) were submitted regarding critically low RN staffing levels on the night shift but no action had been taken. Six PERs were submitted and reviewed, and appropriate follow-up actions were taken. We partially substantiated the allegation that two patients waited over 9 hours for emergency care. ED staff completed intake assessments within a reasonable time period based on the patients’ medical conditions. We recommended that the System Director implement a policy that includes an ED augmentation plan for additional RNs, providers, and support staff in times of acute overload or disaster and review orientation processes for RNs floating to the ED.