Healthcare Inspection Alleged Urology Consult Scheduling Delays, Cincinnati VA Medical Center, Cincinnati, OH

OIG conducted a healthcare inspection in response to a confidential complainant’s concerns regarding delays in the scheduling of urology outpatient consults at the Cincinnati VA Medical Center (facility), Cincinnati, OH. Specific allegations included the following: The Urology Section scheduler retired and was not replaced for 7 months; The new scheduler was floated from the Urology Section to work in other locations; The new scheduler was not fully trained for the position; As of July 10, 2015, about 160 veterans were still awaiting an initial appointment even though their providers had requested urology outpatient consult services as early as May 2015. We substantiated that after the Urology Section scheduler retired, a new scheduler was not assigned to the Urology Section until 7 months later. However, other schedulers filled the gaps in coverage. We also substantiated that although the new Urology Section scheduler was required to work in other locations, we found that the scheduler worked the majority of his/her time in the Urology Section. We did not substantiate that the scheduler was not fully trained for his/her duties when assigned to the Urology Section. We substantiated that as of July 6, 2015, 166 Urology Section outpatient consults remained in pending or active status. However, while 85 (52 percent) were pending or active for more than 30 days, 81 (48 percent) of the consults were not over 30 days old. By August 31, 2015, the number was reduced to 11. To assess patient outcomes related to scheduling delays, we reviewed the electronic health records of 39 patients who had outpatient urology consults requested between January 1–August 31, 2015 that remained in a pending or active status for greater than 30 days and who had inpatient hospital stays before August 31, 2015. We did not find evidence that delays in outpatient urology consult appointment scheduling contributed to patients’ hospital admissions within the time frame of the review. We found that from January 11 through May 23, 2016, the scheduling improvements we noted in August 2015 were maintained, with no more than eight urology outpatient consults in a pending or active status. A review of outstanding consults in June 2016 confirmed that problems with delays in consult scheduling had not recurred. Because the consult scheduling improvements were sustained, we made no recommendations.