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YELLOW SHEET Office of the State Auditor of Missouri |
June 26, 2002
Report No. 2002-47
Using a risk assessment
system would increase the effectiveness of hospital inspections, and target
resources in potentially substandard facilities
This audit reviewed hospital
inspections and complaint investigations performed by the Department of Health
and Senior Services staff and identified ways to use resources more
effectively.� The following highlights
our findings:
Inspections not targeted to
at-risk facilities
Department staff work
reactively by conducting broad inspections when due by law and focused
investigations on complaints.� This approach
does not consider factors that could identify facilities potentially providing
substandard care.� Under the current approach,
department staff routinely inspect all systems of a hospital's operations for
state law compliance, even though the law allows inspections limited to
specific systems. �(See pages 4 and 6)
High-priority complaint
investigations initiated more quickly
A 2000 department internal
review showing untimely complaint investigations prompted the department to
focus full-time resources to high-priority complaints.� This shift in focus worked.� Prior to the change, the department had 19
high-priority complaints with untimely investigations, but only had three
untimely investigations after the change.�
(See page 4)
Some on-site complaint
investigations not always timely conducted
Auditors found 18 complaints
with untimely on-site investigations.� The
elapsed time between receiving the complaint and starting the required on-site
investigation ranged from several weeks to more than a year.� In two of these cases, the on-site
investigation had not started as of the end of audit fieldwork. �(See page 4)
Deficiencies cited in
inspections not effectively tracked until recently
Before July 2001, department staff recorded investigation and inspection results on separate systems. �As a result the number, severity and frequency of deficiencies were not tracked or monitored for trends, which would be useful in assessing risk.� (See page 7)
Many complaint
investigations unfounded
During the audit period, bureau staff did not cite deficiencies in 55 percent of the 491 investigations of complaints considered �of less serious concern.�� Surveyors stated the concerns of complainants often proved to be inaccurate after reviewing medical records and interviewing hospital staff.� (See page 4)
