Comprehensive Healthcare Inspection of the VA Maine Healthcare System in Augusta

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report describes the results of a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the VA Maine Healthcare System, which includes the Togus VA Medical Center and multiple outpatient clinics in Maine. This evaluation focused on five key operational areas:• Leadership and organizational risks• Quality, safety, and value• Medical staff privileging• Environment of care• Mental health (suicide prevention initiatives)The OIG issued 12 recommendations for improvement in all five areas:1. Leadership and organizational risks• Sentinel events and institutional disclosures2. Quality, safety, and value• Root cause analysis for patient safety events3. Medical staff privileging• Ongoing Professional Practice Evaluation data• Focused Professional Practice Evaluation reporting• VISN oversight of credentialing and privileging processes4. Environment of care• Environment of care inspections• Panic and over-the-door alarm testing• Maintaining a safe environment• Hazard warning signs• Safe and clean patient care areas5. Mental health• Comprehensive Suicide Risk Evaluation completion