VA Initiative Enhances Safety of Inpatient Surgery Services

WASHINGTON — The Department of Veterans Affairs (VA), the nation’s largest health care system, today announced measures to ensure that all inpatient surgeries are performed under the safest possible conditions at facilities with the resources to support them.  

VA is the first hospital system to conduct a comprehensive review to determine what level of inpatient surgeries may be performed in each of its 112 surgery programs.  

“VA began this major undertaking in 2007 to close and prevent gaps in surgical care,” said Dr. Robert Petzel, VA’s Under Secretary of Health.  “Our mission is to provide the best health care to Veterans, and we are determined to meet uncompromising standards for inpatient surgery.”  

After an expert work group’s review of surgical standards, VA conducted on-site studies of each of its hospitals between June 2009 and March 2010.  As a result, VA has assigned each of its medical centers an inpatient “surgical complexity” level — complex, intermediate or standard. 

Based on appropriate criteria developed by 16 surgical advisory boards including 80 experts, VA has authorized 66 hospitals to conduct “complex” inpatient surgeries; 33 hospitals to conduct “intermediate” inpatient surgeries; and 13 to conduct “standard” inpatient surgeries.  

Hospitals with a “complex” rating require special infrastructure (facilities, equipment and staff) allowing intricate operations, such as cardiac surgery, craniotomies and total pancreatectomies.  Those with an “intermediate” rating may perform surgeries such as colon resections, repairs of abdominal aortic aneurysms and complete joint replacement.  Those with a “standard” complexity rating may perform inpatient surgeries requiring limited infrastructure, such as hernia repair, cholecystecomy, urologic procedures and ENT surgeries.   

“We are committed to expand Veteran access to quality care,” added Petzel.  “If a patient requires a surgical procedure that exceeds the facility’s complexity rating, VA will ensure that the patient receives the required care from another provider.”

Five facilities that have previously conducted some “intermediate” surgeries will now perform “standard” surgeries in-house and ensure that Veterans obtain other procedures nearby from the best qualified providers.  These are the surgery programs at VA hospitals in Alexandria, La.; Beckley, W.V.; Fayetteville, N.C.; Illiana at Danville, Ill.; and Spokane, Wash.   

VA does not anticipate that any Veteran surgery will need to be rescheduled at these or other facilities due to the planned launch of the Surgical Complexity Initiative on May 11, 2010.

While aimed at ensuring patient safety and high-quality care for all Veterans, the initiative will affect only a very small number of surgical procedures.  VA provided over 357,000 inpatient surgeries for Veterans during 2009, and based on 2009 figures anticipates that 0.1 percent of “intermediate” or “complex” surgeries (approximately 364) would now be referred to another provider.  

VA’s surgical review program will be continuous, expand to include standards for outpatient surgery, and provide a key tool for ongoing health system improvement.  Each of VA’s 21 hospital networks has developed a surgical strategic plan to ensure that Veterans receive needed care while facilities strengthen quality, safety and service.  

The VA health care system serves nearly 6 million Veterans each year and is the 2010 recipient of the leadership award of the American College of Medical Quality.  The VA health care system is committed to public accountability by publishing its quality performance data online at www.hospitalcompare.va.gov.   

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