Healthcare Inspection - Alleged Telemetry Unit Deficiencies, VA New York Harbor Health Care System, New York, New York

OIG conducted a review to determine the validity of an allegation regarding the quality of patient care on a telemetry unit at the Manhattan Campus of the New York Harbor Healthcare System, New York, NY. We could neither confirm nor refute the allegation that a patient on the telemetry unit was not continuously monitored due to a disconnected telemetry lead, malfunctioning monitoring equipment, or short staffing. However, we identified two system weaknesses that increased the risk of patients not being adequately monitored: (1) medical record documentation by unit staff did not meet industry or facility requirements, and (2) telemetry unit nursing and biomedical engineering staff were not trained to properly use the telemetry monitoring equipment. We made two recommendations to address these system weaknesses. Management agreed with the findings and recommendations and provided acceptable improvement plans.