Review of Veterans Health Administration’s Emergency Department and Urgent Care Center Operations During the COVID-19 Pandemic

The VA Office of Inspector General (OIG) conducted a review of the Veterans Health Administration’s response to anticipated demand and use of emergency department and urgent care center services when faced with the possibility of an influx of patients needing evaluation during the COVID-19 pandemic. A survey was deployed and 63 emergency department and urgent care center directors were interviewed.The OIG learned there was a decreased number of patient visits to the emergency departments (19.8 percent decline) and to the urgent care centers (28.6 percent decline) for January–June 2020 when compared with the same time frame in 2019.Other issues described by interviewees included a small number of rooms with negative pressure and small waiting rooms that made it difficult to isolate or separate patients with known or suspected COVID-19. Twenty-three emergency department and urgent care center directors reported a loss of staff due to providers testing positive for the virus, transfers, resignations, or retirements. COVID-19 testing was generally available at the selected facilities. Some directors reported a lack of or need to ration certain items of personal protective equipment. Regular communications with leaders that addressed the most recent COVID-19 topics were informative and helpful.Data related to supplies, clinical treatment, COVID-19 epidemiology, and hospital utilization were deemed critical and helpful for decision making. Virtually all respondents stated that they closely monitored staff for signs of fatigue and burnout.Lessons learned included patient and provider COVID-19 education, rethinking how emergency or urgent care can be delivered in a pandemic, and redesigning the day-to-day operations of the work place. The directors also noted the need to preserve the capability to provide emergency or urgent care for non-COVID-19 patients while attending to the special care needs of patients with COVID-19.