Deficiencies in Select Community Care Consult (Stat) Processes During the COVID-19 Pandemic

The VA Office of Inspector General (OIG) conducted a national review of stat community care consults generated during the outset of the COVID-19 pandemic to evaluate consult processes. Patient involvement in care urgency disagreements and reporting of adverse events in community care were also reviewed. When the OIG identified deficiencies in processes, electronic health records (EHRs) of the patients at issue were further examined for potential negative outcomes. The OIG did not identify any negative care outcomes. For the 2,236 stat community care consults generated from March 20, 2020, through June 30, 2020, that were in an active, scheduled, or completed status, the OIG reviewed the community medical provider documentation contained in patients’ EHRs and determined the following: • Care was not provided within 24 hours for 379 (16.9 percent) consults. • Care was provided as requested for 2,049 consults (91.6 percent) irrespective of being within or outside of 24 hours. The OIG conducted an electronic survey regarding facility stat community care consult processes and identified: • Approximately 10 percent of facilities reported not processing stat consults in community care. Of these, almost three-fourths referenced difficulties meeting consult requirements, such as preauthorization of care, obtaining community provider medical documentation, and completing consults within 24 hours. • Of the facilities that responded, almost one-fourth indicated the chiefs of staff or designees changed the urgency statuses of consults from stat to routine without collaborating with the referring providers. The OIG made six recommendations to the Under Secretary for Health related to community care resources, facility practices, and VHA requirements that specifically focused on stat community care consults: • Retrieval of medical records and administrative closure • Urgency override process • Patient involvement in clinical decision-making regarding consult urgency status • Time frame for adjudicating clinical appeals • Adverse event–reporting processes