Improved Oversight of Surgical Support Elements Would Enhance Operating Room Efficiency and Care

The VA Office of Inspector General (OIG) examined whether the Veterans Health Administration (VHA) effectively used data from its National Surgery Office (NSO) to identify and address problems affecting operating room efficiency. The audit focused on four elements needed for efficient and timely surgeries: clinical service staff, sterile processing and logistics services, the environmental management service, and resource management. The OIG found that leaders of VHA’s regional networks and medical facilities did not consistently use NSO data to improve operating room efficiency. The audit team estimated (under non-pandemic conditions) that greater regional and facility oversight of surgical support elements would improve operating room efficiency and reduce surgical cancellations by 8,600 over five years, save an estimated $30 million, and improve surgical services for about 7,200 patients. Problems at less efficient facilities persisted for at least two years because regional and facility leaders did not effectively monitor operating room efficiency and follow up when less efficient facilities did not resolve underlying problems in surgical support elements. The surgical workgroups for the less efficient facilities focused primarily on surgical outcomes, while VHA’s more efficient facilities focused on both surgical outcomes and operating room efficiency. VHA concurred with the OIG’s six recommendations, including developing an oversight mechanism to ensure that regional networks monitor and hold medical facilities accountable for addressing persistent problems in operating room efficiency and surgical support elements. Other recommendations address periodic assessments of operating room efficiency data to identify medical facilities with persistent problems, clarifying and refining selected NSO performance measures, identifying best practices and implementing them when appropriate at less efficient facilities, and more broadly sharing efficiency data across medical facility service lines. One recommendation was closed at publication and all others will be monitored until completed.