GAO Faults VA Hospitals’ Admissions : Report Says Third of Patients Studied Didn’t Belong There

About one-third of the patients studied in Veterans Administration hospitals in 1984 did not belong there and were admitted because of mismanagement and poor testing by doctors, the General Accounting Office said today.

In a report, the congressional watchdog agency concluded that the VA could save billions of dollars on planned expansion by cutting unnecessary admissions and excessive stays at its 172 hospitals across the country.

The report found that hospital stays for many patients could be reduced if VA hospital officials would adopt patient management practices widely used in the medical community.

Guidelines Issued

“VA’s central office has issued policy guidelines which recommend using many of these practices,” the GAO said. “However, managers at the hospitals GAO visited have not fully implemented the policies and therefore keep patients hospitalized longer than necessary.”

The report said a corresponding review of 350 patients treated at seven VA hospitals in 1982 found that 43% of the days they spent hospitalized were “medically avoidable.”

About half those excess days resulted from poor patient management, such as admitting the patient and then needlessly waiting several days before performing surgery, the study said.

The other half occurred when patients were kept in the hospital because cheaper alternatives, such as nursing homes and hospice beds, were unavailable.

VA Administrator Harry N. Walters, in a letter to the GAO, agreed with some of the criticism and said some problems are already being corrected. He challenged, however, whether savings would be as great as the report suggested.

Walters also said that savings from shifting people to less costly out-of-hospital facilities is impossible if the facilities are not available.

“Unless it can be demonstrated that alternate treatment facilities actually existed and could have accommodated patients, it does not seem reasonable for GAO to conclude that patients are hospitalized inappropriately,” he wrote.

Numerous Examples

GAO investigators cited the following examples of wasteful practices at VA hospitals:

--A man was admitted on a Friday and remained over the weekend awaiting an operation on Tuesday.

--A man with blood in his urine was admitted for tests he should have had as an outpatient.

--A woman was admitted for seven days for cancer tests she should have had as an outpatient.

--A man was kept 10 unnecessary days before he was sent to a nursing home.

The GAO report was based on two reviews of VA hospital patients. In the first, the agency’s consultant team of doctors and nurses reviewed 350 randomly selected medical files of patients at seven hospitals who were discharged in 1982.

In the second review, the GAO’s chief medical adviser visited six of the seven VA hospitals in 1984 to evaluate conditions of patients in medical and surgical beds.