Improvements Needed in Quality Assurance for Open Heart Surgery

HRD-84-22: Published: Feb 24, 1984. Publicly Released: Feb 24, 1984.

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GAO reviewed the policies, procedures, and practices of the Veterans Administration's (VA) Department of Medicine and Surgery (DM&S) for assessing and ensuring the quality of open heart surgery programs at VA medical centers.

DM&S relies on an expert committee of VA and non-VA physicians to assess the quality of open heart surgery programs and to identify problem open heart surgery programs. However, GAO found that DM&S has not required this committee to follow its guidelines regarding when it would assess a program's quality and how it would communicate the results to the medical centers. GAO believes that, since the guidelines are not always followed, the committee's conclusions on the quality of certain programs may be questionable and inaccurate. DM&S also relies on the medical centers to ensure that quality care is provided in their open heart surgery programs by using problem-oriented, systematic internal reviews, among other techniques.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: On April 8, 1986, the Director of the Surgical Service issued instructions for paper audits on cardiac surgery deaths to all members of the Cardiac Surgery Consultants Committee. The instructions comply with this recommendation.

    Recommendation: The Chief Medical Director, DM&S, should require the Director of the Surgical Service to issue specific directives stating when the Cardiac Surgery Consultants Committee is to conduct paper audits, what the audits are to include, and how the results are to be communicated to DM&S and the individual open heart surgery programs.

    Agency Affected: Veterans Administration

  2. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Chief Medical Director, DM&S, should require the Director of the Surgical Service to ensure that the committee conducts audits and makes visits when appropriate, that the audits include all reported mortality cases, and that the conclusions reached by the committee are communicated to the program officials.

    Agency Affected: Veterans Administration

  3. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Chief Medical Director, DM&S, should require the Director of the Surgical Service to follow up on the actions taken as a result of recommendations in the committee's paper audits and site visit reports.

    Agency Affected: Veterans Administration

  4. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Chief Medical Director, DM&S, should require medical centers whose open heart surgery programs experienced low utilization or high mortality rates to conduct problem-oriented, systematic, internal reviews of their programs.

    Agency Affected: Veterans Administration

 

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