Healthcare Inspection – Excessive Length of Stay and Quality of Care Issues in the Emergency Department, William Jennings Bryan Dorn VA Medical Center, Columbia, SC

The VA Office of Inspector General Office of Healthcare Inspections conducted an evaluation in response to allegations of an excessive length of stay (LOS) and lack of treatment for elevated blood pressure in the Emergency Department (ED) at the William Jennings Bryan (WJB) Dorn VA Medical Center (the facility) in Columbia, SC. During our inspection, an anonymous complainant further alleged that acuity levels for various conditions were triaged lower than indicated by ED guidelines. We substantiated the patient’s excessive LOS in the ED, and determined it to be a chronic problem at the facility. Emergency Department Integration Software (EDIS) was not utilized to provide data to assist in improving flow management and ED providers considered EDIS data entry a low priority. We did not substantiate that the facility failed to address a patient’s elevated blood pressure in the ED or that urgent or critical conditions were triaged at non-urgent levels. We recommended that the Facility Director identify a reporting structure for EDIS data and ensure that mandated quarterly reports containing and utilizing EDIS data are provided, ensure that planned actions to address patient flow (hire additional providers and extend hours for the non-urgent area) are implemented and patient flow outcomes are monitored, and that ED providers and other clinical and administrative staff receive training on the use of EDIS delay reasons and that accuracy is monitored.