Comprehensive Healthcare Inspection of the Southern Arizona VA Health Care System in Tucson

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the inpatient and outpatient care provided at the Southern Arizona VA Health Care System, which includes the Tucson VA Medical Center and multiple outpatient clinics in Arizona. This evaluation focused on five key operational areas:• Leadership and organizational risks• Quality, safety, and value• Medical staff privileging• Environment of care• Mental health (emergency department and urgent care center suicide prevention initiatives)The OIG issued six recommendations for improvement in three areas:1. Leadership and organizational risks• Sentinel events and institutional disclosures2. Environment of care• Inspection frequency and documentation• Inspection deficiency tracking• Infectious materials signage• Environmental safety and cleanliness3. Mental health• Patient follow-up for suicide risk