VHA Needs More Reliable Data to Better Monitor the Timeliness of Emergency Care

The VA Office of Inspector General (OIG) determined whether Veterans Health Administration (VHA) emergency department oversight ensured patients received emergency care services in a timely manner and whether facilities made any needed improvements to the patient flow process, which is how patients move through a facility from arrival to discharge or admission. Emergency departments measure timeliness using software that records this process. Some 2.3 million patients visit VHA’s 110 emergency departments each year. The data is necessary for VHA to determine how long patients waited to be seen, treated, and discharged. The OIG found data were inconsistently entered and contained inaccuracies. The OIG recognizes that emergency department staff may provide care first out of necessity before documenting it. However, data problems hindered identification of needed improvements in the patient flow process and the effectiveness of corrective action plans. The OIG found VHA’s data and evidence in patients’ electronic health records indicated that some patients with the most critical needs did not always receive emergency care within VHA timeliness thresholds. While the patients assessed in this audit were not found to have experienced clinically significant adverse outcomes due to their wait, VHA can improve its monitoring of the data for the patients most at risk. The OIG also identified possible data manipulation by the Baltimore VA Medical Center emergency department director that made it appear patient discharge or admission times were shorter than actual wait times. The director has since been replaced. The OIG made five recommendations to improve VHA’s emergency department oversight, including ensuring the Baltimore VA Medical Center reevaluates its corrective action plan, training staff on how to accurately record triage times, strengthening reliability reviews to improve data accuracy, establishing routine oversight for data reliability, and monitoring data of patients with the most severe needs receiving emergency care.