OIG identifies radiology scheduling and staffing problems at Phoenix VA

An investigation by the U.S. Department of Veterans Affairs has substantiated a number of allegations regarding appointment scheduling, staffing and other administrative issues leveled against the radiology department of the Carl T. Hayden VA Medical Center in Phoenix.

The Phoenix VA Health Care System was at the center of a national scandal that enveloped the VA last year when news reports alleged that at least 40 U.S. military veterans died while waiting for care at the Phoenix VA facilities.

The investigation into the radiology department was a separate inquiry that was launched after someone filed an anonymous complaint last August. Investigators from the Office of the Inspector General (OIG) Office of Healthcare Inspections subsequently found that:

• Employees used a Microsoft Outlook software calendar for scheduling, which breached VA security requirements.
• Radiology appointments were not reflected on patients’ appointment reminder lists and that radiology clerks didn’t have access to the scheduling system.
• The radiology department had no written scheduling guidelines and no formal training plan for clerks.
• Radiology films and files were stored in the facility’s basement and were not readily accessible to staff.
• There were times the department had insufficient clerical staff scheduled, meaning there were times the department’s check-in area had no coverage in the case of unscheduled absences.

The OIG found that understaffing led to long lines of patients waiting to be checked in and sometimes created an "overwhelming" work environment for staff. During the site visit, for example, OIG investigators found that the MRI section had no clerical staff and that technologists were temporarily fulfilling clerical functions.

According to the report, the Phoenix VA facility records and categorizes complaints and comments from patients according to issues. In the 2014 fiscal year the radiology department was the subject of 158 patient contacts, just 11 of which were compliments.

The top three categories of complaints were phone calls not answered or returned (30%), excessive delay in scheduling or rescheduling an appointment (24%), and the delay or postponement of a test or procedure (21%). The OIG found that the most frequently cited area patients cited was MRI because of unanswered phone calls or scheduling issues, and that similar complaints extended to CT and ultrasound.

The report recommended that the facility’s interim facility director ensure that:

• The Radiology department uses software that is consistent with VA policy to schedule appointments.
• Radiology department managers explore the use of the scheduling system by radiology clerks to ensure that appointments are reflected on patients’ appointment lists and that automated reminder letters and phone calls are generated or initiated.
• Radiology department managers develop and implement a scheduling policy and a formal training program for clerical staff to ensure consistency in scheduling practices. 4. We recommended that the Interim Facility Director.
• Radiology department managers assess and monitor clerical needs to ensure all check-in areas are staffed, appointments are scheduled/rescheduled, and phones are answered or calls are returned timely.
• Radiology department managers implement the facility’s plan for centralized radiology scheduling and procedures to ensure a timely response to phone calls or messages.

Click here to see the full report.