Additional blame was attributed to short-staffing at VA healthcare facilities, equipment shortages and poor oversight. While four different policies were implemented nationwide by VA radiology leadership in 2016 and 2017 to clear up the backlog, instructions failed to convey clearly who was authorized to review or cancel orders and when.

“There was no clear direction that outlined these expectations,” wrote the auditors, who said that regional oversight was inconsistent in ensuring local facilities followed the guidelines. Local VA managers also failed to see if clinical providers reviewed outdated or overdue orders before they were cancelled, to verify if patients still required examinations recommended for them.


The VA inspector general has referred half a dozen cases out of 113 canceled orders for further review on the grounds that the patients still need the diagnostic exams requested for them. Among the steps being implemented by the VA to avoid similar situations in the future are:

• Distributing a clinic management model that includes guidance for facilities to provide adequate radiology resources, including staffing and equipment.
• Establishing a lead radiologist within each veterans integrated service network (VISN), and delineating responsibilities for monitoring and compliance on access, scheduling, and orders management.
• Evaluating radiology and nuclear medicine scheduling workload and ensuring that medical support assistant staffing is adequately distributed.
• Strengthening audit mechanisms and requirements to monitor and ensure compliance with policies and procedures for canceling exam requests.

The new guidelines are expected to be in complete effect by July 2020.

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