FARGO — The Veterans Affairs Medical Center here sometimes lacked adequate nurse staffing in the emergency department during overnight shifts and did not always ensure that those counseling veterans for sexual trauma received required training, according to a report.

Those were among the findings of the Office of the Inspector General, which gave the medical center generally high marks following an unannounced inspection in March. The report was issued on Thursday, Nov. 7.

The inspection report, which described its findings as a snapshot of the north Fargo medical center’s performance, is part of efforts to improve patient safety and quality of care. Inspectors noted deficiencies in four of eight clinical areas reviewed and made five recommendations for improvements.

Inspectors found that the medical center didn’t always have at least two registered nurses staffing the emergency department, as required, during the night shift.

“This could result in potentially unsafe situations in the emergency department when a single registered nurse may need to provide critical care to multiple patients,” inspectors wrote.

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The emergency department’s nurse manager said administrators were aware of the staffing deficiency, but denied requests to hire additional nurses and used inpatient nursing supervisors for backup coverage.

In response to the inspection report, administrators said they have addressed the staffing shortfall by hiring 2.6 full-time equivalent employees to cover the night shift.

VA administrators agreed with the report’s recommendations and in responses outlined steps for resolving the deficiencies.

“This largely positive report underscores why thousands of North Dakota veterans choose to be treated at the Fargo VA Health Care System year after year,” a statement from the Veterans Health Administration Office of Communications in Washington said. The Fargo Medical Center “operates one of the largest and most complex facilities in the state and is seeing more patients than ever before more quickly than ever before. In addition, the facility compares favorably to nearby non-VA hospitals in many areas."

Inspectors found general compliance with mental health performance indicators, but found that not all mental health and primary care providers completed mandatory training.

Among 13 providers hired after the requirement took effect, five did not complete the training within the required period and four did not complete the training at all, inspectors found. Although post-traumatic stress disorder is commonly associated with military sexual trauma, the report noted, other frequently associated diagnoses include depression and substance abuse disorder.

In other findings, inspectors:

  • Found that women weren’t always notified of abnormal cervical cancer screening results within seven days, as required. Administrators said they identified problems with an alert notification system and have resolved the issue.

  • Identified possible lapses in care in several areas where complications arose more often than in the national or regional VA health systems. Those areas included higher rates for pressure ulcers, in-hospital falls resulting in hip fractures, post-operative kidney injury requiring dialysis, pulmonary embolism or deep-vein thrombosis around the time of surgery and post-operative rupture along incisions. A single incident in any category, inspectors noted, can cause a medical center’s rate to exceed the VA rate during a period of time. Many of the categories showed improvements, and in other cases a review committee determined that patients received appropriate care.

  • Noted surveys of patient experiences consistently showed the Fargo VA Medical Center outperforming the average for the VA system.

The Fargo VA Medical Center “continually strives to improve performance and already has plans in place to complete the Inspector General’s recommendations by January 2020,” the VA statement said.