Community Based Outpatient Clinic Reviews Spring City and Springfield, PA Sarasota and Sebring, FL Paragould, AR and Salem, MO Cottonwood and Lake Havasu City, AZ

The VA Office of Inspector General reviewed eight Community Based Outpatient Clinics (CBOCs) during the weeks of November 16, 2010, and November 29, 2010. CBOCs were reviewed in Veterans Integrated Service Network (VISN) 4 at Spring City and Springfield, PA; in VISN 8 at Sarasota and Sebring, FL; in VISN 15 at Paragould, AR and Salem, MO; and, in VISN 18 at Cottonwood and Lake Havasu City, AZ. The parent facilities of these CBOCs are Coatesville VAMC, Bay Pines HCS, John J. Pershing VAMC, and Northern Arizona VA Health Care System (NAVAHCS), respectively. The purpose of the review was to assess whether CBOCs are operated in a manner that provides veterans with consistent, safe, high-quality health care. The review covered four areas: quality of care measures, credentialing and privileging, environment of care and emergency management, and management of laboratory results. We noted opportunities for improvement and made the following recommendations to VISN and facility managers: Coatesville VAMC: Modify the entrance to improve access for disabled veterans at the Springfield CBOC. Develop a procedure for monitoring and testing panic alarms at the Spring City CBOC. Collect and monitor measurable data for hand hygiene at the Spring City and Springfield CBOCs. Bay Pines HCS: Collect, analyze, and report hand hygiene data at the Sarasota and Sebring CBOCs. Identify the locations of fire extinguishers at the Sarasota and Sebring CBOCs. Improve access for disabled veterans at the Sebring CBOC. Update the local policy for medical and MH emergencies at the Sarasota CBOC. John J. Pershing VAMC: Require providers to document patient notification of normal labs within the specified timeframe at the Paragould CBOC. Collect, analyze, and report hand hygiene data at the Paragould and Salem CBOCs. Conduct fire drills at the Salem CBOC as required by the NFPA. Require that the parent facility follows VA directives and guidelines for real property lease agreements for the Salem CBOC. Require that the parent facility enter into a contract to perform laboratory and other medical services at negotiated prices for the Salem CBOC, or if a contract is not beneficial to the VA, then the Facility Director must ensure that VA directives and guidelines for fee basis care are followed. NAVAHCS: Require the ordering providers at the Cottonwood CBOC to document patient notification and treatment actions in response to critical test results. Ensure clinicians communicate normal test results to patients within the specified timeframe at the Lake Havasu City CBOC. Require the Chief of OI&T to evaluate identified IT security vulnerabilities and implement appropriate IT security measures at the Cottonwood and Lake Havasu City CBOCs. Install panic alarm systems at the Cottonwood and Lake Havasu City CBOCs. Maintain auditory privacy during the check-in process at the Cottonwood CBOC. Develop a local policy or SOP for handling medical and MH emergencies at the Cottonwood and Lake Havasu City CBOCs.