Healthcare Inspection - Emergency Department Quality of Care, Safety, and Management Issues, Dallas VA Medical Center, Dallas, Texas

OIG conducted an inspection to determine the validity of allegations concerning quality of care, safety, and management issues in the emergency department (ED) at the Dallas VA Medical Center (the facility), Dallas, TX. We substantiated allegations of inadequate triage practices by registered nurses (RNs), poor communication, and inappropriate referrals of patients from the primary care clinics (PCCs) to the ED. We did not substantiate allegations of a delayed admission, poor surgery response to ED consultation requests, inadequate staffing, inappropriate scheduling of physicians, and excessive verbal and physical assaults on ED staff. Additionally, we identified improvement opportunities related to orthopedic consultations, the work environment, and the inter-facility transfer process. We recommended that the Facility Director ensure that (1) RN triage practices are consistently performed and that training is completed, (2) communication between the ED and PCCs is improved, (3) managers monitor orthopedic surgery response timeliness, (4) ED managers and staff undergo training to help promote a positive work environment, and (5) the current inter-facility process is assessed and that appropriate administrative support is provided for required paperwork. The VISN and Facility Directors agreed with the findings and recommendations and provided acceptable action plans. We will follow up on the planned actions until they are completed.