Better Patient Management Practices Could Reduce Length of Stay in VA Hospitals

HRD-85-52: Published: Aug 8, 1985. Publicly Released: Aug 8, 1985.

Additional Materials:

Contact:

David P. Baine
(202) 512-7101
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

GAO reviewed Veterans Administration (VA) hospitals to determine whether VA: (1) was effectively managing its medical and surgical patients; and (2) could more efficiently reduce the length of stay for these patients.

GAO found that, although the VA central office issued policy guidelines which recommended that more efficient patient management practices be used and recognized throughout the medical community, its hospital managers have not fully implemented them; therefore, many patients are hospitalized longer than necessary. GAO also found that excessive lengths of stay were attributable to surgery scheduling and times scheduled for conducting and providing the results of diagnostic test and consultations because the VA central office has not established performance expectations in those areas. Performance of diagnostic tests before admission, surgery schedules that keep delays to a minimum, and early discharge planning would contribute to more efficient patient management. VA has two methods to monitor whether efficient patient management practices are being used in its hospitals: (1) the utilization review process performed at the hospital level; and (2) the Systematic External Review Program (SERP) conducted at the central office. However, neither method has been used effectively to reduce the length of patient stays because review personnel sometimes had little or no medical background and the criteria and scope used were often inappropriate. VA believes that implementation of its new resource allocation system will move hospitals toward shorter lengths of stay, more cost-efficient care, greater staff productivity, and greater reliance on alternatives to hospital care.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: A section on utilization review was included in SCEM during the fourth quarter in fiscal year 1985.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to include criteria on the key elements of utilization review in the Standards, Criteria, Evaluative Algorithms, and Measuring Instruments. SERP teams should use the criteria when evaluating each hospital's utilization review program.

    Agency Affected: Veterans Administration

  2. Status: Closed - Not Implemented

    Comments: VA contended that each facility should be allowed to decide when, and to what degree, the reviews should be performed. The revised manual will describe each type of review and allow the centers to choose which to follow.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to require hospitals to conduct all three types of review, concurrent, retrospective, and focused, as part of their utilization review program. Concurrent reviews should be conducted shortly after the patient's admission and periodically throughout the patient's stay. Retrospective reviews should be conducted after patients have been discharged so that the hospital can ensure whether such patient management practices as preadmission testing and discharge planning were carried out. Focused reviews should be conducted either concurrently or retrospectively.

    Agency Affected: Veterans Administration

  3. Status: Closed - Not Implemented

    Comments: VA agreed with the intent of this recommendation, but refused to tell hospitals who to hire. This will be reviewed as part of the facility's SERP review.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to require hospitals to staff their utilization review function with qualified people, including reviewers who have a medical background.

    Agency Affected: Veterans Administration

  4. Status: Closed - Implemented

    Comments: A national education program on utilization review management was conducted between March 1986 and September 1986.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to require hospitals to use explicit patient screening criteria, such as those addressing intensity of care or severity of illness, to evaluate the appropriateness of the level of treatment.

    Agency Affected: Veterans Administration

  5. Status: Closed - Not Implemented

    Comments: VA does not concur with this recommendation and plans no action.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to develop reports at the VA central office and at individual hospitals to identify length of stay problems and those responsible for solving them. These reports could include such analyses as: (1) a comparison of length of stay by selected diagnosis categories at each VA hospital; (2) a comparison of length of stay for each physician's patients in a particular medical or surgical specialty; and (3) a list of patients who have been in the hospital for more than 30 days.

    Agency Affected: Veterans Administration

  6. Status: Closed - Implemented

    Comments: VA issued a policy circular regarding the utilization review issues GAO raised.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to revise current policies to place greater emphasis on reducing surgery delays and turnaround times for diagnostic consultations, tests, and procedures. In making these revisions, the Chief Medical Director should make the current policies and goals more specific, using such guidelines as those developed by the American Hospital Association.

    Agency Affected: Veterans Administration

  7. Status: Closed - Not Implemented

    Comments: VA disagreed, stating that there was not enough time during SERP reviews for physicians to review length of stay issues. However, VA is implementing several other systems, including MEDIPRO, which may achieve the same objective.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to increase the scope of SERP by including evaluations of a random sample of patient case files at each hospital. These evaluations would help measure the effectiveness of hospitals' efforts to minimize lengths of stay and would also help measure the effectiveness of hospitals' utilization review programs. To identify potential length of stay problems, the external review team can use reports and data such as those described above.

    Agency Affected: Veterans Administration

 

Explore the full database of GAO's Open Recommendations »

Sep 20, 2016

Sep 19, 2016

Sep 16, 2016

Jul 29, 2016

Jul 28, 2016

Jun 27, 2016

Jun 6, 2016

May 11, 2016

Apr 28, 2016

Mar 21, 2016

Looking for more? Browse all our products here