Healthcare Inspection – Vascular Surgery Resident Supervision, VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska

OIG conducted an inspection to assess the merit of allegations regarding lack of supervision for vascular surgery residents resulting in poor patient care at the VA Nebraska-Western Iowa Health Care System, Omaha, NE. We did not substantiate the allegation that vascular residents were not supervised by attending surgeons. We found that vascular resident supervision documentation met Veterans Health Administration requirements and the Accreditation Council for Graduate Medical Education (accrediting body for resident supervision programs) guidelines. The six cases identified by the complainant did not demonstrate adverse events or near misses attributable to a lack of resident supervision. During the review, we found that attending surgeons did not cosign vascular surgical resident notes timely. Veterans Health Administration policy requires that facilities define and document the timeframe for cosigning resident notes. While local policy defines a 7-day timeframe for attending surgeons’ co-signature of outpatient resident progress notes, we did not find a documented timeframe requirement for co-signature of inpatient resident progress notes. We did not find that delays in attending surgeons’ co-signatures on resident notes resulted in poor patient care. We made two recommendations. The Veterans Integrated Service Network and System Directors concurred with our findings and recommendations and provided acceptable action plans.