Comprehensive Healthcare Inspection of the Wm. Jennings Bryan Dorn VA Medical Center in Columbia, South Carolina

Veterans Affairs Office of Inspector General (OIG) sent this bulletin at 12/15/2020 01:12 PM EST

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Given VA's phased reopening efforts for its administrations and offices to return to more routine operations, the OIG has resumed its standard publication release practices as well. The release of reports was limited during March through June 22, 2020, in recognition of VA's need to focus on the initial pandemic response. The OIG will remain sensitive to the burdens that may be imposed on VA to respond to additional COVID-19 cases, and will continually assess its report release policy as circumstances warrant.

 

Comprehensive Healthcare Inspection of the Wm. Jennings Bryan Dorn VA Medical Center in Columbia, South Carolina
12/14/2020 07:00 PM EST

This Office of Inspector General (OIG) Comprehensive Healthcare Inspection Program report provides a focused evaluation of the quality of care delivered in the inpatient and outpatient settings of the Wm. Jennings Bryan Dorn VA Medical Center and multiple outpatient clinics in South Carolina. The inspection covers key clinical and administrative processes associated with promoting quality care. This inspection focused on Leadership and Organizational Risks; Quality, Safety, and Value; Medical Staff Privileging; Environment of Care; Medication Management: Long-Term Opioid Therapy for Pain; Mental Health: Suicide Prevention Program; Care Coordination: Life-Sustaining Treatment Decisions; Women’s Health: Comprehensive Care; and High-Risk Processes: Reusable Medical Equipment. The medical center leaders had worked together for nearly two years at the time of the on-site inspection. Survey results indicated that employees were generally satisfied. However, patient survey results indicated multiple opportunities for medical center leaders to improve satisfaction. Review of the medical center’s accreditation findings, sentinel events, and disclosures did not identify any substantial organizational risks. Medical center leaders, other than the Chief of Staff, were knowledgeable within their scope of responsibilities about employee and patient satisfaction survey results and Veterans Health Administration data and/or factors contributing to specific poorly-performing Strategic Analytics for Improvement and Learning quality and efficiency measures. The OIG issued 14 recommendations for improvement in six areas: (1) Medical Staff Privileging • Ongoing professional practice evaluations • Provider exit reviews (2) Environment of Care • Infection prevention and medication safety • Environmental cleanliness • Privacy (3) Medication Management • Aberrant behavior risk assessment • Informed consent • Patient follow-up (4) Mental Health • Patient follow-up • Suicide prevention training (5) Women’s Health • Gynecologic care coverage • Women Veterans Health Committee membership and attendance (6) High-Risk Processes • Equipment storage