Most folks working for the Department of Veterans Affairs are good people dedicated to their mission. But not all are.
Come to find out, the same thing’s true of their patients, according to the charmingly-titled new report, here, from the VA’s inspector general:
Management of Disruptive Patient Behavior at VA Medical Facilities
“Balancing the rights and health care needs of violent and disruptive patients with the health and safety of other patients, visitors, and staff,” the IG said in a report released Thursday, “is a significant challenge for VHA [Veterans Health Administration] facilities.”
But the VA, the IG said, doesn’t have uniform standards for defining such behavior and how it should be handled (Sound familiar, parents?).
“As a result, facilities have applied their own definitions, which are generally not consistent from facility to facility,” the report said. “The lack of a common definition and terminology diminishes VHA’s capacity to collect and analyze national data on disruptive behavior and identify system problems and training needs that could prevent or minimize disruptive behavior.”
A VA survey of 30 facilities for 2011 found each averaged 27 such patients, or about one such case every two weeks.
A 2010 internal survey of 140 VA facilities found that in 2009:
— All 140 facilities had established DBCs [Disruptive Behavior Committees] (or equivalents).
— One-hundred thirty-eight (99 percent) facilities referred a total of 6,472 cases to the DBCs; 2 facilities reported no referrals.
— Of the 6,472 cases, 1,599 (25 percent) resulted in a Category I PRF [Patient Record Flags, warning of a disruptive patient], with 640 of the cases requiring police presence during subsequent patient visits.
— Thirty-two (23 percent) facilities reported banning or barring patients from their facilities; 10 of the 32 provided patients fee basis care.
The IG cited government experts on risk factors for disruptive patients in any kind of health facility:
— Volatile people, especially if they are under the influence of drugs or alcohol or have a history of violence or certain psychotic diagnoses
— Under staffing
— Long waits for service
— Overcrowded, uncomfortable waiting rooms
— Poor environmental design
— Inadequate security
— Lack of staff training and policies for preventing and managing crises
Many of those, of course, sound like veterans’ gripes about the VA.
The VA agreed with the IG that it needs to develop uniform definitions and standards of disruptive patients, and collect it systematically, to try to reduce their number.