VA Health Care:

Too Many Operating Rooms Being Planned and Built

HRD-86-78: Published: Apr 29, 1986. Publicly Released: Apr 29, 1986.

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GAO examined the Veterans Administration's (VA) method for determining operating room requirements in new and replacement hospitals and identified the differences between VA-stated operating room needs and the requirements a GAO surgical work-load model identified.

GAO found that VA is developing an operating room planning model at its Ann Arbor Medical Center that will permit planners to: (1) use independently established utilization rates for each facility, instead of a more efficient agencywide preestablished rate to plan operating room resources and staff; and (2) develop work-load projections to reflect possible changes in planning factors without central office guidance to ensure that projections are consistent, realistic, and in line with current or planned policy. GAO applied its model for determining VA operating room requirements to 24 construction projects and found that VA: (1) is building or plans to build 29 unnecessary operating rooms; (2) could have saved about $5.8 million by applying the GAO model; and (3) could still save about $3.4 million by eliminating 17 unnecessary planned operating rooms.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: VA does not believe that all facilities should be expected to have the same utilization rate. It believes that it is necessary to consider variable factors in determining utilization rates.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to instruct Ann Arbor project officials to develop a final model that will use a preestablished 80-percent utilization rate for determining the number of operating rooms.

    Agency Affected: Veterans Administration

  2. Status: Closed - Implemented

    Comments: VA concurred with this recommendation and stated that appropriate changes to its criteria will be made based upon the final results of the planning model developed by the Ann Arbor project. VA has developed an operating room planning model and has used this model in all projects started in fiscal years 1991 and 1992.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to give planners guidance on how to adjust work-load projections to reflect changes in the model's planning factors and monitor VA planners' calculations of projected work loads to ensure that adjustments are consistent with the guidance.

    Agency Affected: Veterans Administration

  3. Status: Closed - Not Implemented

    Comments: VA believes that the GAO model is outdated because it was developed, to a large degree, based on 1981 data. VA further believes that it would be better to implement a planning model which is based on current cost and work-load variables.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to stop using the current VA operating room planning criterion and use the GAO methodology to determine the required numbers of new or replacement operating rooms until the Ann Arbor model is implemented.

    Agency Affected: Veterans Administration

  4. Status: Closed - Implemented

    Comments: VA agreed with this recommendation and stated that all construction projects in the planning stage should be reassessed based on the new model. VA has developed new operating room planning guidelines and uses these guidelines to reassess its 5-year construction plan each year.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to reassess all existing construction projects to eliminate, where cost-effective, unnecessary operating rooms.

    Agency Affected: Veterans Administration

 

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