Combined Assessment Program Summary Report – Evaluation of Inpatient Flow in Veterans Health Administration Facilities

The VA Office of Inspector General Office of Healthcare Inspections completed an evaluation of coordination of care in Veterans Health Administration facilities. The purpose of the review was to evaluate selected aspects of the Veterans Health Administration patient flow process over the inpatient continuum (admission through discharge). The objectives were to determine whether clinicians complied with requirements for admission assessments, transfer notes, and discharge documentation and whether facilities had clinical Bed Flow Coordinators to coordinate patient flow activities throughout the facility. We conducted this review at 24 Veterans Health Administration medical facilities during Combined Assessment Program reviews performed across the country from October 1, 2015, through March 31, 2016. We observed many positive practices during our review, including that most facilities had committees that monitored patient flow and addressed identified problems or opportunities for improvement, most facilities had appointed clinical Bed Flow Coordinators, and clinicians documented providing patients with a copy of the discharge instructions the patients understood. However, we identified system weaknesses in discharge policy content, policies addressing overflow patients in temporary bed locations, and documentation of resident supervision for discharge notes or instructions. We made three recommendations.