Alleged Delay in Surgical Care, Lack of Resident Oversight, and Improper Physician Pay at Edward Hines, Jr. VA Hospital, Hines, Illinois

The VA Office of Inspector General (OIG) conducted a healthcare inspection to assess the validity of allegations regarding a delay in performing an appendectomy, that the delay was caused by inadequate resident oversight, and surgeons paid by the VA were unavailable because they were working for other institutions. The OIG substantiated a delay of approximately three hours occurred in performing an appendectomy. The OIG team determined the delay was due to another patient requiring surgery more urgently and poor communication. No adverse event occurred due to the delay. The facility’s practice for scheduling surgeries did not address communication among key staff during the multiple steps between identifying the need for surgery and the time of surgery. Opportunities existed for facility leaders to evaluate communication between residents and surgeons. The OIG did not substantiate that the appendectomy was delayed because of inadequate resident oversight. Staff interviews and electronic health records confirmed that general surgery attendings were available at all hours to provide resident supervision and discuss patients, and were present in the operating room during surgeries. The OIG team was unable to determine the availability of surgeons or if they were working at other institutions while paid by the VA. Discrepancies existed with general surgeons’ reported hours and timecards for May 2018. The facility indicated that they did not maintain documents detailing part-time physicians’ tours of duty. The Veterans Integrated Service Network Fiscal Quality Assurance Manager also conducted a review of part-time physician hours and determined the facility did not maintain appropriate documentation. The OIG made two recommendations related to evaluating the surgery scheduling processes, and ensuring the adequacy of documentation for part-time physicians’ tours of duty and responsibilities for time and attendance.