Healthcare Inspection – Quality of Care and Other Concerns Robert J. Dole VA Medical Center, Wichita, Kansas

OIG conducted a healthcare inspection at the Robert J. Dole VA Medical Center (facility) in Wichita, KS, in response to a July 15, 2015 request from former Congressmen Tim Huelskamp and Mike Pompeo to review mortality rates for patients transferred to the intensive care unit (ICU) and other quality of care concerns. VA Inpatient Evaluation Center (IPEC) is a program that measures and reports Veterans Health Administration (VHA) facilities’ quarterly mortality data. We found that the mortality rate for patients transferred from the inpatient medical/surgical unit to the ICU was not higher than other similar VA hospitals at the time of the congressional inquiry in 2015. During one quarter in 2014, we found the facility did not meet national VHA mortality rate benchmarks. We found that facility leaders were notified about the IPEC data, and consulted with VHA level program offices about practices and processes. During our July 21, 2015 unannounced site visit, we found one nocturnist physician working and did not observe doctors playing video games. Anesthesiology and surgery staff were required to return to the facility during off-hours within a specific timeframe if an urgent patient care need arose; however, for other attending physicians, we found that facility policy was not well-defined. We reviewed 28 ICU patients’ quality of care and did not find evidence of inadequate or inattentive care. During FY 2015 first 2 quarters, facility staff transferred 4 patients out of 668 ICU admissions to community hospitals. We found transfers were justified because facility medical services were unavailable. However, we found system deficiencies in VHA and facility policy compliance and identified a nocturnist coverage concern. Facility staff reported that the Emergency Department (ED) provider would leave the ED to perform intubations when mid-level providers, who could not perform emergency intubation, worked as nocturnists. We confirmed this practice when we reviewed one of the EHRs, which documented the ED provider performed an intubation outside of the ED. We recommended that the Facility Director implement recommendations from previous event-related reviews, strengthen Hospice/Palliative Care processes, assign Palliative Care Consult Team staff, assess the need to define the required timeframe for attending physicians to return to the facility, comply with facility policy for clinicians who perform emergency airway management, comply with VHA policies on ED coverage, and use qualified physician nocturnists.