Healthcare Inspection – Alleged Excessive Wait for Emergency Care and Staff Disrespect, VA Southern Nevada Healthcare System, Las Vegas, Nevada

OIG conducted an inspection at the VA Southern Nevada Healthcare System (facility), Las Vegas, NV, in response to a request from the House Committee on Veterans’ Affairs Chairman Jeff Miller and Congresswoman Dina Titus. The OIG evaluated the merit of allegations that a patient experienced an excessive wait for emergency care and that staff repeatedly disrespected the patient. We found that in October 2013, an elderly patient spent 5 hours and 6 minutes in the facility’s emergency department (ED), waiting 4 hours and 45 minutes to be evaluated by an ED physician. We concluded that a wait of this length was challenging for this patient. However, mitigating this long wait was the fact that numerous other patients who were assessed to be in more urgent need of attention were in the ED at the same time. The facility’s target is for less than 10 percent of its ED patients to experience a total ED length of stay of greater than 6 hours. The facility met this target on only 1 day during the week in which the patient visited the ED. The purpose of triage in the ED is to prioritize incoming patients and to identify those who cannot wait to be seen. The patient’s wait time to be triaged by a registered nurse was 63 minutes. During the patient’s multi-hour waiting period, there was no documentation of hourly nursing reassessments as required by local policy. We found no relationship between the length of the patient’s ED wait and her subsequent clinical course. We did not substantiate the allegations of staff disrespect. OIG made two recommendations.