9 p.m., Sept. 28
VA Hospital Audit Finds Fire Risks, Cancer Test Delays
There have been big troubles with colorectal cancer tests and many fire extinguishers, including those in an operating room, have gone without safety checks at San Diego's Veterans Administration hospital, accordng to a critical report released Friday by the Inspector General of the U.S. Veterans Affairs Department.
Those are just some of the problems unearthed by federal inspectors during their October audit of hospital procedures.
Entitled "Combined Assessment Program Review of the VA San Diego Healthcare System," the January 6 report says:
"We found fire extinguishers without current safety checks in the CLC (Community Living Center), medicine, surgery, and mental health units and in the operating room."
Regarding colorectal cancer screening, "We reviewed the medical records of 20 patients who had positive CRC screening tests, and we interviewed key employees involved in CRC management.
"VHA requires that patients receive diagnostic testing within 60 days of positive CRC screening test results unless contraindicated.
"Of the 20 patients, 4 had appropriate consults submitted, but diagnostic testing was not scheduled or completed, " the report continued. "Twelve of the 16 patients who received diagnostic testing did not receive that testing within the required timeframe."
In addition, official procedure requires that test results be "communicated to patients no later than 14 days from the date on which the results are available to the ordering practitioner and that clinicians document notification.
"Thirteen of the 16 patients who had diagnostic testing did not have documented evidence of timely notification in their medical records."
"VHA also requires that patients who have a biopsy receive notification within 14 days of the date the biopsy results were confirmed and that clinicians document notification.
"Of the 12 patients who had a biopsy, 10 records did not contain documented evidence of timely notification."
Various pre-sedation rules were also violated, the inspectors said.
"VHA requires that providers document a complete history and physical examination and/or pre-sedation assessment within 30 days prior to a procedure where moderate sedation will be used.
"None of the medical records reviewed had documentation of the time and nature of last oral intake, and eight did not include a review of tobacco use."
In addition, "VHA requires that the patient’s signature consent be obtained prior to sedation and that the pre-procedure timeout include verification of a valid consent form."
"Although the timeout we observed included verification of documented informed consent, one medical record contained no evidence that the patient’s signature consent was obtained prior to sedation even though timeout documentation stated that informed consent was verified."
The audit added, "Although we found evidence of monthly medical record quality reviews, we did not find evidence of strong, specific action items documented in Medical Record Committee meeting minutes."
According to a report endnote, hospital management has begun remedying the problems, with clean-up all remaining issues promised by March 1.
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