Wilmington VA placed on internal "high risk" watchlist
Wilmington Veterans Affairs Medical Center in Elsmere was placed on a "high-risk" watch list earlier this year because of declining performance, according to internal documents obtained by USA Today.
The documents detail the hospital's standing among VA hospitals nationwide and shed light on the recent change in leadership. In November, Robin C. Aube-Warren, the hospital's top manager since 2014, was removed, with VA officials citing "performance issues" at the hospital for the change.
The VA ranks its hospitals using one through five stars. Centers with more stars are performing better. The internal documents detail the star ratings for every facility in the VA system for the fourth quarter of 2015. The ratings are based on dozens of factors, including death and infection rates, instances of avoidable complications and wait times.
Wilmington was ranked as a two-star center, according to the hospital administration. Hospitals with lower ratings are given more scrutiny and attention from national officials, VA Undersecretary for Health David Shulkin told USA Today.
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That appears to be what has been in progress in Wilmington in recent months.
The distinction came months before the reassignment of Aube-Warren, who took a job at NASA shortly after she was ousted from Wilmington.
She was replaced by Robert Callahan, director of the Lebanon VA Medical Center in Pennsylvania, on an interim basis. The hospital is searching for a permanent leader. He said his role is to assess performance issues and chart a path forward.
The internal statistics shed some light on how the hospital has fared in recent years.
Figures comparing in-hospital quality measures from 2013 to 2016 show a slight increase in the rate of deaths for those who are in the hospital for 30 days with an urgent medical condition. While there has been an increase, Wilmington is above average in this area.
The rankings also show an increase in the number of “avoidable” in-hospital complications and that the hospital is below average compared to other VA centers in that category.
In an interview Wednesday, Callahan said the measurements do not tell the full story about the quality of care at the hospital. Because the hospital is relatively small, one or two cases can greatly affect the rankings.
"A small number is driving this," said hospital Chief of Staff Dr. Robert Boucher.
The statistics show patient satisfaction has gone down alongside employee morale.
The assessment data does show improvement in wait times for new patients as well as a decrease in nurse turnover, though, the center remains below average compared to other VA hospitals in those categories.
Callahan said the hospital ranks average or better when it comes to veteran satisfaction, call responsiveness and technical quality of inpatient and outpatient care and ranks above local private hospitals in some areas.
Sandra Cahall, president of Local 342 of the American Federation of Government Employees and a registered nurse at the Wilmington facility, said Callahan has brought changes to the hospital, though he's only been managing it for about two months.
"You have to give the VA credit for looking at what is wrong," Cahall said.
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She said recently the hospital has fast-tracked hiring in some positions and there is greater emphasis on educating managers of what they will be held accountable for within their units.
Callahan said morale has been one of the glaring needs.
"There is a need to focus on people. We are not ranked very well on the best places to work in terms of employee satisfaction," Callahan said. "When you look at what Wilmington has been through in the past two years, it is no wonder why."
Along with implementing various operational changes, the hospital has hired 47 clinical employees since Sept. 1 in an attempt to improve care.
While declining performance was cited in Aube-Warren's reassignment, Delaware's senior Sen. Tom Carper said the hospital's care has improved and he believes she was a scapegoat for the removal of three southern New Jersey outpatient clinics from the Wilmington VA's oversight recently.
In March, Egg Harbor Township Navy veteran Charles R. Ingram III, 51, died after dousing himself with gasoline and setting himself ablaze outside the Northfield Veterans Clinic, which was closed for the weekend.
The suicide prompted New Jersey politicians to push for changes. In May, VA officials and members of New Jersey's congressional delegation announced the three southern New Jersey clinics were to be removed from Wilmington VA oversight and see increased staffing levels.
"You hold the commanding officer responsible for what happened," Carper said. "I think that Robin is being held responsible for a sad incident that occurred outside of one of the (outpatient clinics)."
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Carper said there needs to be some consistency in the management of the hospital to make meaningful improvements in care.
"My ask would be to find an exceptional leader, let them receive the kind of support and resources they need and let them stay for a while," Carper said.
Contact Xerxes Wilson at (302) 324-2787 or xwilson@delawareonline.com. Follow @Ber_Xerxes on Twitter.