Federal Reports

The Postal Service began implementing the Dynamic Route Optimization (DRO) initiative in fiscal year (FY) 2016. The initiative allows for morning Highway Contract Routes (HCR) to change from a fixed-price contract with set routes (static) to a rate per mile (RPM) contract with varying departure times, lines of travel, and mail types transported based on mail volume (dynamic) to optimize routes thus reducing mileage and transportation costs. Our objective was to evaluate the cost savings for implementing DRO.

News reports have raised concerns about foreign threats to the United States biomedical research enterprise. In a letter to institutes receiving National Institutes of Health (NIH) funding, the Director of NIH highlighted concerns about diversion of intellectual property; sharing of confidential information from grant applications; and the failure by some NIH funded researchers to report substantial financial support from other organizations, including foreign governments. Our objective was to determine whether NIH has policies, procedures, and controls in place for helping to ensure that institutions report all sources of research support, financial interests, and affiliations.

This evaluation issued nine recommendations to address findings in the areas of leadership, Volunteer health support, Volunteer safety and security support, training, and site management. Recommendations were directed to staff at the post with the exception of one recommendation that was directed to the regional director. We did not have any findings in the areas of Volunteer administrative support and programming.

This is a publication by GAO's Office of Inspector General (OIG) that concerns internal GAO operations. The OIG contracted with the independent certified public accounting firm of Williams Adley to audit GAO’s compliance with the Digital Accountability and Transparency Act of 2014 (DATA Act), and produce this report. This report addresses (1) the completeness, accuracy, timeliness, and quality of the financial and award data GAO submitted for publication on USASpending.gov for the first quarter of fiscal year (FY) 2019 and (2) GAO’s implementation and use of the Government-wide financial data standards established by the Office of Management and Budget (OMB) and the Department of the Treasury.

This Comprehensive Healthcare Inspection Program (CHIP) provides a focused evaluation of the quality of care at the Hunter Holmes McGuire VA Medical Center, covering leadership, organizational risks, and key processes associated with promoting quality care. Areas of focus were Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Controlled Substances Inspections; Mental Health: Military Sexual Trauma Follow-Up and Staff Training; Geriatric Care: Antidepressant Use among the Elderly; Women’s Health: Abnormal Cervical Pathology Results Notification and Follow-Up; and High-Risk Processes: Emergency Department and Urgent Care Center Operations. The facility had generally stable executive leadership, but the OIG had concerns with long-term Nursing Service leadership vacancies and minimal recruitment efforts. Employee satisfaction and patient experiences in the inpatient and specialty care settings also need improvement. The leadership team should review steps to identify cases that may need institutional disclosures and evaluate the process of identifying improvement opportunities. The leadership team needs to improve their knowledge about selected SAIL and CLC metrics and the actions necessary to sustain and improve performance that contribute to the SAIL “4-star” and CLC “1-star” quality ratings. The OIG issued 21 recommendations: (1) Quality, Safety, and Value • Physician utilization management advisors’ documentation • Root cause analyses • Resuscitative episode reviews (2) Medical Staff Privileging • Focused and ongoing professional practice evaluation processes (3) Environment of Care • General cleanliness and safety (4) Controlled Substances Inspections • Controlled substances inventories/checks, documentation, and reconciliation • Pharmacy inspections and medication destruction • Verification of prescription pads and written prescriptions (5) Military Sexual Trauma (MST) Follow-up and Staff Training • MST training (6) Antidepressant Use among the Elderly • Patient/caregiver education and understanding of medications • Medication reconciliation (7) Abnormal Cervical Pathology Results Notification and Follow-up • Full-time women veterans program manager (8) Emergency Departments and Urgent Care Center Operations • Licensed mental health provider availability • Directional signage

The VA Office of Inspector General (OIG) conducted a rapid response inspection to evaluate allegations that some patients, presenting with mental health-related issues to the Louis Stokes Cleveland VA Medical Center Emergency Department, were not adequately assessed prior to transfer to the facility’s Psychiatric Observation and Assessment Center (PAOC), thus placing patients with medical conditions at risk. The OIG substantiated the allegation; however, the conditions described in the allegation generally occurred prior to August 2018 and facility policy then did not require patients with primarily mental health concerns to be screened in the Medical Emergency Department first. Following visits from The Joint Commission and the Office of Medical Inspector in July 2018, the facility changed its policy to require that all patients presenting with intoxication or an acute mental health condition are medically screened in the Emergency Department before transfer to the PAOC. To determine if the facility was following the new policy, the OIG reviewed 205 encounters for patients seen in the Emergency Department and subsequently transferred to the PAOC between January 1 and March 31, 2019. The OIG did not substantiate that patients were transferred to the PAOC without medical screening examination notes, were transferred in acute alcohol withdrawal, or were transferred with critical laboratory values. The OIG found no evidence of adverse clinical outcomes related to the management of patients receiving care in the PAOC. In March 2019, the facility issued a policy that defined the procedures for evaluation and treatment of patients presenting with suspected substance intoxication and provided mandatory Clinical Institute Withdrawal Assessment training for all Emergency Department and PAOC staff. The OIG made one recommendation related to the clinical elements to be included in a medical screening examination to deem a patient medically stable prior to transfer to the PAOC.