Delays and Deficiencies in Management of Selected Radiology and Nuclear Medicine Outpatient Exams

Report Information

Issue Date
Report Number
18-02300-236
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Recommendations
8
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
The VA Office of Inspector General (OIG) conducted this review to determine if the Veterans Health Administration (VHA) completed radiology and nuclear medicine exam requests and follow-up care in a timely manner. The audit team also reviewed two related hotline allegations and determined if VHA managed canceled requests appropriately nationwide. The audit team estimated that 17 percent of routine exams and 25 percent of urgent exams were not completed within the required time frames. Reasons included staff and equipment shortages, issues with staff allocation, and insufficient monitoring of the scheduling process. Additionally, facility staff did not consistently follow radiology and nuclear medicine policy for canceled outpatient requests. Inappropriate cancellations can lead to delayed or incomplete exams and increase patient wait times. The audit team found that most follow-up care was completed appropriately. Facility staff either attempted to complete the recommended follow-up care with veterans or confirmed that they received it. The OIG made several recommendations to the under secretary for health to address management issues on the facility and regional levels. Among the recommendations were ensuring that facility staff evaluate the workload for scheduling exam requests and monitor requests that have been pending for more than seven days, implementing a mechanism to routinely audit canceled exam requests and take corrective action as needed, developing and implementing a plan for improving radiology and nuclear medicine oversight regionally, and creating a method for sharing new guidance with radiology and nuclear medicine leaders. The audit team also substantiated allegations of inappropriate exam cancellations at the James A. Haley and Iowa City VA medical centers. The issues were addressed in the general recommendations.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Ensure facility staff evaluate scheduling workload and that medical support assistant staffing is adequately distributed for scheduling radiology exam requests in a timely manner.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Provide formal guidance to facilities for establishing clinic management models for adequate radiology resources, including staffing and equipment.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Ensure facility radiology and nuclear medicine services monitor exam requests pending greater than seven days and address them in a timely manner.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Confirm with each facility director that they reviewed each record and took appropriate action as they deemed necessary for the three completed requests with additional follow-up care needs.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Develop and implement a plan for improved radiology and nuclear medicine oversight at the Veterans Integrated Service Network level.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Implement a mechanism to routinely audit canceled exam requests, ensuring the requests are in accordance with VA radiology and nuclear medicine policies and procedures for canceling exam requests, and taking corrective actions as needed based on audit results.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Create a method to notify radiology and nuclear medicine leaders at all VA medical facilities when guidance is released. The method should be streamlined with maximum distribution and ensure receipt and acknowledgment by affected radiology and nuclear medicine leaders.
No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
Confirm with each facility director that they review each record and take appropriate action for five of the six canceled requests with outstanding exam needs.