JHQ 303: Delays in Care During the COVID-19 Pandemic in the Veterans Health Administration-JHQ 303 Article

JHQ 303 Article

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This Veterans Health Administration (VHA) quality-improvement analysis examined COVID-19–related delays in care using patient safety reports submitted to the Joint Patient Safety Event Reporting System (JPSR) from January 1 to November 15, 2020. From 7,158 COVID-relevant safety reports identified by keyword search and natural language processing, 897 were categorized as delay-related. A stratified random sample of 200 was reviewed; 148 reports met inclusion criteria and were coded for delay type, harm, setting, duration, and contributing factors (high interrater reliability, κ=0.92).<br /><br />The most frequent delays involved laboratory results (33.8%), particularly COVID-19 testing, which often triggered downstream delays such as postponed emergency procedures, canceled surgeries, delayed cardiac/GI interventions, and delayed transfers to appropriate levels of care (e.g., ICU admission contingent on test results). Other common delay categories included delays in obtaining the right level of care, delays in treatment or interventional procedures, delays in specific aspects of care (often linked to testing or isolation requirements), radiology delays, medication administration delays, and delayed diagnoses (including cancer, which sometimes extended from days to months).<br /><br />When causes could be determined (76% of cases), leading contributors were poor staff-to-staff communication, failures in specimen collection/handling or follow-up on labs, confusion about policies, and misunderstanding COVID-specific rules. Additional factors included clinic/unit closures, equipment unavailability, PPE shortages, staffing shortages, and fear of exposure. Delays occurred most often on inpatient units and in emergency departments.<br /><br />The authors recommend reducing pandemic-related delays by standardizing infection-testing workflows (including pathways for emergencies), strengthening communication through SBAR and visual/huddle tools, and using simulation to test new protocols, uncover latent safety risks, and rapidly train staff.

Keywords

Veterans Health Administration

quality improvement analysis

COVID-19 care delays

Joint Patient Safety Event Reporting System

patient safety reports

laboratory result delays

COVID-19 testing workflow

staff communication failures

inpatient and emergency department delays

simulation and protocol standardization