VA Health Care

The Quality of Care Provided by Some VA Psychiatric Hospitals Is Inadequate Gao ID: HRD-92-17 April 22, 1992

None of the four Department of Veterans Affairs (VA) psychiatric hospitals GAO visited is effectively collecting and using quality assurance data on a consistent basis to identify and resolve quality-of-care problems in the psychiatric and medical care that patients are receiving. As a result, questionable psychiatric practices may go unnoticed, and medical procedures or practices that are known to have contributed to deaths or medical complications may continue. VA and non-VA hospital systems GAO visited, both psychiatric and acute medical/surgical, differ little in their approach to identifying quality-of-care problems. The quality assurance mechanisms each uses to make sure that quality-of-care standards are met are similar because most use the Joint Commission on Accreditation of Healthcare Organizations as its primary external review group. Further, many of the problems discovered in VA hospitals have also been found in non-VA hospitals.

GAO found that: (1) none of the four VA psychiatric hospitals visited are effectively collecting and using the kind of quality assurance data needed to demonstrate that their psychiatric programs fully meet patients' psychiatric needs, primarily because VA has not defined requirements for evaluating psychiatric programs, and nurses and physicians in two hospitals are not documenting the reasons why they place patients under restraints and seclusion; (2) hospital staff in two VA hospitals were not timely correcting quality assurance problems identified through patient incident reports; (3) unnecessary deaths occur in VA hospitals because medical staff do not use available quality assurance data to correct identified problems; (4) VA and non-VA hospitals' quality assurance programs are similar; and (5) quality-of-care problems resulting in complications or death occurred in both VA and non-VA hospitals.

Recommendations

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