VA wait time scandal: How agency resolved 56,000 cases of delayed care in one day

The Department of Veterans Affairs has resolved most of the 56,000 cases of patients who waited too long for care by shutting down operations for a day to focus on those cases, according to a case study published by the NEJM Catalyst.

The article, by David Shulkin, M.D., the Department of Veterans Affairs undersecretary for health, said staff set out during the one-day stand down to identify the veterans at greatest risk from a delay in care. They looked at charts to see what type of medical problems for which they were awaiting follow-up appointments, prioritized them, and contacted the highest-priority veterans to perform an updated clinical assessment and update the plan of action.

Among the choices for resolution: clinicians asked the patient to immediately visit a VA medical center or a closer medical facility, staff created additional time slots so the veterans could be seen sooner, or staff documented that the patient had already seen a provider and no longer needed a consultation.

The VA now uses the data analytics developed for the stand down to create real-time dashboards that show all urgent consults and their wait times, according to the article. That action comes as the VA rolls out two new systems--the Veteran Appointment Request App and the VistA Scheduling Enhancement--and possibly a broader effort known as the Medical Appointment Scheduling System (MASS).

Among the lessons learned from the case study, Shulkin wrote, is that systemic problems require new processes that will prevent reoccurrence, and that stand downs "should be considered as tools to address both short-term and long-term objectives."

To learn more:
- read the case study