Comprehensive Healthcare Inspection of the Birmingham VA Medical Center in Alabama

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Birmingham VA Medical Center and multiple outpatient clinics in Alabama. The inspection covers key clinical and administrative processes that are associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment. At the time of this inspection, the medical center’s leaders had been working together for four days. Employee satisfaction scores were generally similar to or better than VHA averages. Selected patient experience scores generally reflected similar or lower ratings than the VHA average. The OIG’s review of the medical center’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risk factors. However, the OIG identified a repeat finding related to dirty floors in patient care areas. The executive leaders were extremely knowledgeable within their scopes of responsibilities about VHA data and/or system-level factors contributing to specific poorly performing Strategic Analytics for Improvement and Learning measures. The OIG issued 18 recommendations for improvement across seven areas: (1) Quality, Safety, and Value • Root cause analyses (2) Medical Staff Privileging • Professional practice evaluations • Provider exit review processes (3) Environment of Care • Cleanliness and infection prevention procedures • Patient health information protection (4) Medication Management • Aberrant behavior risk assessment • Concurrent opioid and benzodiazepine therapy • Urine drug testing • Informed consent (5) Mental Health • Suicide safety plans • Suicide prevention training (6) Women’s Health • Women’s health primary care providers (7) High-Risk Processes • Annual risk analysis