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VA Hospitals: Surgical Residents Need Closer Supervision

HRD-86-15 Published: Jan 13, 1986. Publicly Released: Jan 13, 1986.
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Highlights

In response to a congressional request, GAO reviewed Veterans Administration (VA) hospitals' supervision of surgical residents to determine whether: (1) the supervision is adequate; (2) VA is monitoring this supervision; and (3) the supervision in VA hospitals is comparable to that in non-VA hospitals.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Veterans Administration The Administrator of Veterans Affairs should direct the Chief Medical Director to revise VA criteria on supervision of surgical residents so that the criteria are no less specific than GAO criteria. The revised criteria should define the appropriate actions for preoperative and postoperative supervision.
Closed – Implemented
VA revised its manual to include this recommendation.
Veterans Administration The Administrator of Veterans Affairs should direct the Chief Medical Director to require that VA hospital chiefs of surgery enforce criteria for surgical resident supervision. This enforcement should include not allowing surgeons whose schedules do not permit supervising all three phases of surgery to supervise residents.
Closed – Implemented
VA modified its manual to indicate that, generally, one supervising surgeon would supervise all three phases of surgery and, if this is not possible, the supervising surgeons should communicate.
Veterans Administration The Administrator of Veterans Affairs should direct the Chief Medical Director to designate either the Office of Quality Assurance or the Surgical Service office within the Department of Medicine and Surgery as having the primary responsibility for monitoring supervision of residents and indicate that all pertinent information on such supervision should be given to that office.
Closed – Implemented
A circular was issued in March 1987.
Veterans Administration The Administrator of Veterans Affairs should direct the Chief Medical Director to specify and standardize the systems VA hospitals should use to monitor and report on the supervision of surgical residents.
Closed – Implemented
VA modified its manual to standardize the reports on supervision of residents.
Veterans Administration The Administrator of Veterans Affairs should direct the Chief Medical Director to ensure that the VA hospitals send the Surgical Service the results of their annual audits of the adequacy of surgical resident supervision.
Closed – Implemented
A circular was issued in March 1987.
Veterans Administration The Administrator of Veterans Affairs should direct the Chief Medical Director to revise VA criteria on supervision of surgical residents so that the criteria are no less specific than GAO criteria. The revised criteria should relate the five levels of intraoperative supervision to the level of the resident and complexity of the case.
Closed – Implemented
VA modified its manual to relate the level of the resident to the level of supervision.
Veterans Administration The Administrator of Veterans Affairs should direct the Chief Medical Director to revise VA criteria on supervision of surgical residents so that the criteria are no less specific than GAO criteria. The revised criteria should address the credentials of the supervising surgeon.
Closed – Implemented
VA revised its manual in response to the recommendation that its criteria address the credentials of the supervising surgeon.
Veterans Administration The Administrator of Veterans Affairs should direct the Chief Medical Director to revise VA criteria on supervision of surgical residents so that the criteria are no less specific than GAO criteria. The revised criteria should clarify the provision exempting certain residents from the criteria.
Closed – Implemented
VA modified its manual to clarify this exemption.
Veterans Administration The Administrator of Veterans Affairs should direct the Chief Medical Director to require that VA hospital chiefs of surgery enforce criteria for surgical resident supervision. This enforcement should include not allowing scheduled surgery to proceed unless the preoperative criteria are met.
Closed – Implemented
VA concurred with the recommendation and implemented it through a change to the manual.

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Topics

Health care personnelHospital administrationHospital care servicesMonitoringPatient care servicesSurgeryVeterans hospitalsPatient careHospitalsVeterans