Better Guidelines Could Reduce VA's Planned Construction of Costly Operating Rooms

HRD-81-54: Published: Mar 3, 1981. Publicly Released: Mar 3, 1981.

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The Veterans Administration (VA) is planning to spend more than $1 billion to replace 10 of its medical centers. Each replacement center will have a surgical suite, which is among the most costly hospital departments to construct and operate.

In reviewing operating room utilization at centers that VA intends to replace, GAO found that, on the average, the 74 operating rooms at these centers were idle about 50 percent of the time that they were available for scheduled surgery. The current planning criterion used by VA calls for 1 operating room for every 28 surgical beds. The continued use of this criterion could result in overconstruction of operating rooms with resulting low utilization. In developing its criterion, VA did not recognize that not all patients admitted to surgical beds undergo surgery. VA did not fully recognize the significant variation among medical centers in the type of surgical procedures performed and the length of time different surgical procedures take. Average operating times varied significantly among VA medical centers. Surgical procedures generally performed by medical school residents at affiliated centers took longer than similar procedures performed by VA staff at nonaffiliated centers. GAO developed a model for planning operating rooms which focused on the unique surgical work-load characteristics of each VA center. It showed that VA could handle the surgical work load with 22 fewer operating rooms than planned using the present criterion, a potential $3.5 million saving. VA assigned more operating room (OR) nurses than needed to handle the surgical work load due to this criterion, and savings could be realized if VA made use of less-skilled personnel to do many of the nonprofessional tasks now handled by OR nurses.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: VA repeatedly stated to Congress that it was researching a new model for sizing surgical suites. Refer to GAO report HRD-86-78, April 29, 1986.

    Matter: Congress should not approve any funding requests for new or replacement surgical suites in VA centers based solely on room-to-bed ratios, unless the planning is so far along that adjusting the surgical suite(s) planned would not be economically feasible.

Recommendations for Executive Action

  1. 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 Administrator of Veterans Affairs should direct the Chief Medical Director to better use skilled OR nurses by assigning nonprofessional tasks to less skilled personnel.

    Agency Affected: Veterans Administration

  2. Status: Closed - Implemented

    Comments: The VA Chief Medical Director has abolished the Staffing Management Program, and this recommendation is considered closed by VA.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to develop staffing guidelines for OR nurses based on the number of operating rooms needed to handle the surgical work load.

    Agency Affected: Veterans Administration

  3. Status: Closed - Not Implemented

    Comments: This was covered in a later GAO report, HRD-86-78.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to use operating room estimates obtained from the GAO model, or a similar work load model, to reassess the number of operating rooms needed at the Minneapolis VA Medical Center and use such a model for all future construction proposals submitted to Congress. If, in the judgment of VA, more operating rooms are needed than called for by the work load model, the Chief Medical Director should be required to justify the additional rooms.

    Agency Affected: Veterans Administration

  4. Status: Closed - Not Implemented

    Comments: This was covered in a later GAO report, HRD-86-78.

    Recommendation: The Administrator of Veterans Affairs should direct the Chief Medical Director to discontinue use of current VA operating room planning criterion in favor of a planning methodology based on surgical work load for new or replacement operating rooms similar to the one developed by GAO, with the aim of achieving an 80-percent operating room utilization level.

    Agency Affected: Veterans Administration

 

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