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Antibiotic Stewardship Program (ASP): The Facts and the Volente Solution

Where did the ASP come from?

Effective Nov. 28, 2017, all Medicare and Medicaid-certified nursing homes must have an antibiotic stewardship program that includes antibiotic-use protocols and a system to monitor antibiotic use as part of their infection prevention and control program (IPCP), according to §483.80 (Infection Control) of the Code of Federal Regulations. The antibiotic stewardship program is a component of the Phase 2 rollout of the Reform of Requirements for Long-term Care Facilities, and surveyors will assess compliance with this new requirement of participation under F-tag 881 (ASP) during the Infection Control Facility Task that is a mandatory part of the new survey process.  

Is the ASP in effect now?

Yes, it went into effect on Nov. 28, 2017 but CMS has given an 18-month enforcement moratorium to all SNFs for several of the F-tags associated with the Phase 2. This includes F-Tag 881 for Antibiotic Stewardship. This mean they need to the best of their abilities to follow the ASP but when the State does their annual survey they will not be penalized at this point.

What is the purpose of the ASP?

Antimicrobial stewardship is a coordinated program with CMS and each individual state that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. In a nutshell; reduce the use of antibiotics in SNFs to prevent creation of superbugs.  

“…a set of commitments and actions designed to optimize the treatment of infections while reducing the adverse events associated with antibiotic use.”

-Centers for Disease Control and Prevention 

How will this be done at the SNF level?

  • Leadership Support
  • Accountability
  • Drug Expertise
  • Policies to support optimal Antibiotic use
  • Tracking: Monitoring antibiotic prescribing, use and resistance
  • Reporting information to staff on improving use and resistance
  • Education 

Who serves on the committee for the SNF?

  1. Medical Director
  2. At least 1 attending prescriber
  3. Housekeeping
  4. Director of Nursing (DON)
  5. Dietary Services
  6. Pharmacist
  7. Executive Director
  8. Laboratory personnel

How Often do they need to meet and communicate?

Once a month for the operational staff, Quarterly for the Medical Director. Communications need to be distributed monthly to all members and in person to operational members.

What are the penalties if SNFs do not meet these standards?

There will be combination of the following; civil money penalties, payment denials for new admissions, or termination of their Medicare certification. Failure to comply will also affect their Star rating.

What is the 5 Star Rating for SNF?

CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions. The ratings are based on the State Surveys for Health Inspections, Staffing and Quality Measures (QMs). A drop in Star Rating can have a great financial impact just as an increase in the Star Rating can increase profitability.  

Are most Skilled Nursing Facilities prepared for the ASP?    

NO!!!! They are looking for a Champion to come in and show them the best way to meet the regulations while not putting more of a burden on the existing staff. 

What Solution can Volente Healthcare provide?

Program vs Product – Yes, Volente is Diagnostic Laboratory but when it comes to Antibiotic Stewardship we are Volente Healthcare which has a packaged solution to ASP. There are several aspects the SNFs are looking for when they think about ASP; Education, Clinical, Pharmacy, Reporting, Staffing, Compliance and Cost. The Volente Healthcare program for ASP will address each of these issues.

How does the Volente Healthcare ASP Program solve these issues?

  1. Education – The Volente website will provide multiple Continuing Education modules on Antibiotic Stewardship. These certified CE courses will not only provide the needed education required for ASP they will also provide needed CE credits for the facilities medical staff. These courses have been reviewed by the Volente medical and pharmaceutical staff to assure they cover the most important aspects of the ASP.
  2. Clinical – The main issue that first needs to be addressed with ASP is does the patient have a Bacterial or Viral infection. By using the Volente; Gastro Dx, UTI Dx, Wound Dx, and Respi Dx clinically it can be determined if they have a bacterial or viral infection. To those patients which have a repeated bacterial infection or issues with their antibiotics the Volente Antibiotic Resistance Dx panel can determine the best medication therapy for them.
  3. Pharmacy – The Volente staff of pharmacists have been certified and trained to properly read all of the Volente test panels to help determine the best medication outcome for the facilities residents. The pharmacist will then work with the facilities pharmacy to create the needed medication management to eradicate the Bactria while assuring the use of the proper Antibiotic based on the patient’s DNA.
  4. Reporting – Working together the Volente medical and IT staff have created the needed monthly reports that the state surveyors will be reviewing to see that the ASP standards have been met. These reports can quickly be reviewed by the ASP Committee members for them to sign off on each month.
  5. Staffing – The ASP protocols are asking for the SNFs to have one ID champion on staff to oversee the program. Volente will provide staff members to allow them access to experts in the operational, medical and pharmaceutical fields that can provide the needed knowledge for this position to find all their answers at one source.
  6. Compliance – By assisting with the Educational, Clinical, Pharmacy, Reporting and Staffing needs Volente will help assure that each SNFs is in compliance with the ASP standards for their annual survey.
  7. Cost- Beyond the cost of the patients testing needs there are no additional costs associated with the Volente Healthcare ASP Program. 

You can contact Volente direct by going to their website www.volentedx.com

What is PTSD and What Can We Do About It?

What Is PTSD and What Can We Do About It?

Veteran Suicides: a National Public Health Issue

http://www.moaa.org//Veteran-Suicides-a-National-Public-Health-Issues

September 29, 2017

20: the average number of veterans a day who died in this country from suicide
14: the number of veterans who are not under VA care
65: the percentage of all veterans who died by suicide who were age 50 or older
67: the percent of all veteran deaths by suicide as a result of firearm injuries

Find out what the VA and Congress are doing to fight this national crisis.

This week, the VA winds down its suicide prevention awareness month campaign and outreach efforts.

During September, the VA released findings of a detailed analysis of veteran suicide data from all 50 states, as well as Puerto Rico and the District of Columbia. The analysis was part of its earlier comprehensive examination of more than 55 million records, from 1979 to 2014, as the VA sought to develop and evaluate suicide prevention across the country.

“These findings are deeply concerning, which is why I made suicide prevention my top clinical priority,” said VA Secretary Dr. David Shulkin in a press release earlier this month.

“I am committed to reducing Veteran suicides through support and education.” Shulkin said. “We know that of the 20 suicides a day that we reported last year, 14 are not under VA care. This is a national public health issue that requires a concerted, national approach.”

Closing out the month, Congress held a hearing this week to consider several bills to address mental health services in the VA and veteran suicides, as well as a hearing on Wednesday, Sept. 27, where Shulkin offered testimony to the Senate Committee on Veterans’ Affairs regarding how he is addressing suicide prevention in his department.

“Suicide is a terrible, terrible loss of life – a preventable loss of life,” said committee chair Sen. Johnny Isakson (R-Ga.) in his opening remarks before the committee. “It is a disease, and it is preventable, and there are many things we can do to set the example, including promoting training through our staff and throughout government.”

As the largest integrated suicide prevention program in the country, the VA has over 1,000 mental health professionals, but more must be done to address the mental health needs of veterans accessing the system, six of whom die by suicide every day, as well as the larger number of veterans-the 14 committing suicide each day who aren’t accessing the system because there are not enough health care providers or because other barriers preventing them from getting the necessary care in or outside the system.

While Shulkin outlined a number of initiatives undertaken in recent months, including establishing a suicide prevention advisory group, developing a patient record flagging system to identify and monitor patients, and establishing a suicide prevention program at every facility, the secretary urged the committee’s support in helping him to get more mental health professionals into the VA system, more research dollars, and more public awareness across America, as suicide is everyone’s business.

“Our goal is to eliminate suicide,” said Shulkin. “As stated earlier, six Americans will die during the course of this hearing – I think about this every day – I think about how many veterans are dying every day because we aren’t effective at addressing this problem.”

He went on to emphasize data show VA health care treatment saves lives, but it can’t help those veterans not in its system. The VA intends to remain committed to eliminating veteran suicides through more aggressive efforts aimed at risk identification, effective treatments, research, and strategic partnerships.

Additionally, the House Committee on Veterans’ Affairs held a hearing the day prior to consider several bills aimed at preventing suicide and providing enhanced care for veterans suffering from mental health conditions. Some of these bills include:

  • H.R. 1063, Veteran Prescription Continuity Act-ensures transitioning servicemembers receiving medical treatment from DoD receive the medications required when they transfer to a VA medical facility.
  • H.R. 2225, Veterans Dog Training Therapy Act-allows the VA to conduct a pilot program on dog training therapy by entering into agreement with certified non-government entities at a minimum of three but not more than five VA medical centers.
  • H.R. 2327, Puppies Assisting Wounded Servicemembers (PAWS) Act of 2017-directs the secretary to give grants to eligible organizations to provide service dogs to veterans suffering from severe mental disorders such as post-traumatic stress disorder.
  • H.R. 2147, Veterans Treatment Court Improvement Act of 2017-requires the secretary to hire additional veterans justice outreach specialists to provide treatment court services for veterans in the criminal justice system.

The message in both hearings this week was clear: There is much more to be done to reverse the trend on veteran suicides, and MOAA will work with the secretary and members of Congress to make sure the VA has the tools and resources it needs to address this critical public health problem in order to eradicate veteran suicide.

MOAA members can help too. Learn more about the VA’s suicide prevention program and how you can Be There to Save a Life .

Vet Suicide Update

Female Vet Rate 250% Higher Than Non-Vet.

According to newly released statistics from the U.S. Department of Veteran Affairs (VA), a female veteran is 2.5 times more likely to commit suicide than a non-veteran American adult woman. This U.S. veteran suicide statistics report analyzed suicide data for all 50 states, looking at the cross-sections of age and gender as well as the most common suicide methods. Among the top findings of the report:

  • The highest rate of veteran suicides occur in Western states—most happen in the heaviest populated areas in the country.
  • 65 percent of all veterans who committed suicide were 50 years or older.
  • The female veteran suicide rate is 250 percent higher than that for non-veteran females.

“Every Veteran suicide is a tragic outcome,” The VA said in one of the facts sheets of the report. “Regardless of the numbers, one Veteran suicide is too many. VA is leading national efforts to understand suicide risk factors, develop evidence-based intervention strategies, and provocatively identify and care for Veterans who are in crisis or at a risk for suicide.” Other key findings in the report:

  • In 2014, an average of 20 veterans died by suicide every day.
  • In 2014, about 67 percent of all veteran deaths by suicide were the result of firearm injuries.
  • Behind firearm injuries, poison is the second most common method.
  • From 2001 to 2014, the suicide rate among all veterans increased by 31.1 percent.

With the shocking statistics of female veteran deaths by suicide, the VA has made efforts to cater to female veterans by developing the Women Veterans Call Center, a free resource to call or chat anonymously with online. The center receives on average 80 calls per day and makes 1,000 daily calls to women veterans. The call center is available Monday through Friday 8am-10pm ET and Saturdays 8am-6:30pm ET at 855-829-6636.

“We can all play 53 a role in preventing suicide and it doesn’t require a grand gesture of complicated task,” the VA said on its suicide prevention website. “Your actions can help someone going through a tough time to feel less alone.”

Source: The Daily Dot | Brianna Stone | September 19, 2017

Post-Traumatic Stress Disorder

Overview

PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened even when they are not in danger.

Signs and Symptoms

Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.

To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

  • At least one re-experiencing symptom
  • At least one avoidance symptom
  • At least two arousal and reactivity symptoms
  • At least two cognition and mood symptoms

Re-experiencing symptoms include:

  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Frightening thoughts

Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include:

  • Staying away from places, events, or objects that are reminders of the traumatic experience
  • Avoiding thoughts or feelings related to the traumatic event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Arousal and reactivity symptoms include:

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping
  • Having angry outbursts

Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Cognition and mood symptoms include:

  • Trouble remembering key features of the traumatic event
  • Negative thoughts about oneself or the world
  • Distorted feelings like guilt or blame
  • Loss of interest in enjoyable activities

Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.

It is natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

Do children react differently than adults?

Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. In very young children (less than 6 years of age), these symptoms can include:

  • Wetting the bed after having learned to use the toilet
  • Forgetting how to or being unable to talk
  • Acting out the scary event during playtime
  • Being unusually clingy with a parent or other adult

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge. For additional information, visit the Learn More section below. The National Institute of Mental Health (NIMH) offers free print materials in English and Spanish. These can be read online, downloaded, or delivered to you in the mail.

Risk Factors

Anyone can develop PTSD at any age. This includes war veterans, children, and people who have been through a physical or sexual assault, abuse, accident, disaster, or many other serious events. According to the National Center for PTSD , about 7 or 8 out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men, and genes may make some people more likely to develop PTSD than others.

Not everyone with PTSD has been through a dangerous event. Some people develop PTSD after a friend or family member experiences danger or harm. The sudden, unexpected death of a loved one can also lead to PTSD.

Why do some people develop PTSD and other people do not?

It is important to remember that not everyone who lives through a dangerous event develops PTSD. In fact, most people will not develop the disorder.

Many factors play a part in whether a person will develop PTSD. Some examples are listed below. Risk factors make a person more likely to develop PTSD. Other factors, called resilience factors, can help reduce the risk of the disorder.

Risk Factors and Resilience Factors for PTSD

Some factors that increase risk for PTSD include:

  • Living through dangerous events and traumas
  • Getting hurt
  • Seeing another person hurt, or seeing a dead body
  • Childhood trauma
  • Feeling horror, helplessness, or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
  • Having a history of mental illness or substance abuse

Some resilience factors that may reduce the risk of PTSD include:

  • Seeking out support from other people, such as friends and family
  • Finding a support group after a traumatic event
  • Learning to feel good about one’s own actions in the face of danger
  • Having a positive coping strategy, or a way of getting through the bad event and learning from it
  • Being able to act and respond effectively despite feeling fear

Researchers are studying the importance of these and other risk and resilience factors, including genetics and neurobiology. With more research, someday it may be possible to predict who is likely to develop PTSD and to prevent it.

Treatments and Therapies

The main treatments for people with PTSD are medications, psychotherapy (“talk” therapy), or both. Everyone is different, and PTSD affects people differently so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health provider who is experienced with PTSD. Some people with PTSD need to try different treatments to find what works for their symptoms.

If someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be addressed. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.

Medications

The most studied medications for treating PTSD include antidepressants, which may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Antidepressants and other medications may be prescribed along with psychotherapy. Other medications may be helpful for specific PTSD symptoms. For example, although it is not currently FDA approved, research has shown that Prazosin may be helpful  with sleep problems, particularly nightmares, commonly experienced by people with PTSD.

Doctors and patients can work together to find the best medication or medication combination, as well as the right dose. Check the U.S. Food and Drug Administration website (http://www.fda.gov/ ) for the latest information on patient medication guides, warnings, or newly approved medications.

Psychotherapy

Psychotherapy (sometimes called “talk therapy”) involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but it can last longer. Research shows that support from family and friends can be an important part of recovery.

Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.

Effective psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms. One helpful form of therapy is called cognitive behavioral therapy, or CBT. CBT can include:

  • Exposure therapy. This helps people face and control their fear. It gradually exposes them to the trauma they experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened. The therapist uses these tools to help people with PTSD cope with their feelings.
  • Cognitive restructuring. This helps people make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about something that is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.

There are other types of treatment that can help as well. People with PTSD should talk about all treatment options with a therapist. Treatment should equip individuals with the skills to manage their symptoms and help them participate in activities that they enjoyed before developing PTSD.

How Talk Therapies Help People Overcome PTSD
Talk therapies teach people helpful ways to react to the frightening events that trigger their PTSD symptoms. Based on this general goal, different types of therapy may:

  • Teach about trauma and its effects
  • Use relaxation and anger-control skills
  • Provide tips for better sleep, diet, and exercise habits
  • Help people identify and deal with guilt, shame, and other feelings about the event
  • Focus on changing how people react to their PTSD symptoms. For example, therapy helps people face reminders of the trauma.

Beyond Treatment: How can I help myself?

It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better. If you are unsure where to go for help, ask your family doctor. You can also check NIMH’s Help for Mental Illnesses page or search online for “mental health providers,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.
To help yourself while in treatment:

  • Talk with your doctor about treatment options
  • Engage in mild physical activity or exercise to help reduce stress
  • Set realistic goals for yourself
  • Break up large tasks into small ones, set some priorities, and do what you can as you can
  • Try to spend time with other people, and confide in a trusted friend or relative. Tell others about things that may trigger symptoms.
  • Expect your symptoms to improve gradually, not immediately
  • Identify and seek out comforting situations, places, and people

Caring for yourself and others is especially important when large numbers of people are exposed to traumatic events (such as natural disasters, accidents, and violent acts). For more information, see the Learn More section, below.

Next Steps for PTSD Research

In the last decade, progress in research on the mental and biological foundations of PTSD has lead scientists to focus on better understanding the underlying causes of why people experience a range of reactions to trauma.

  • NIMH-funded researchers are exploring trauma patients in acute care settings to better understand the changes that occur in individuals whose symptoms improve naturally.
  • Other research is looking at how fear memories are affected by learning, changes in the body, or even sleep.
  • Research on preventing the development of PTSD soon after trauma exposure is also under way.
  • Still other research is attempting to identify what factors determine whether someone with PTSD will respond well to one type of intervention or another, aiming to develop more personalized, effective, and efficient treatments.
  • As gene research and brain imaging technologies continue to improve, scientists are more likely to be able to pinpoint when and where in the brain PTSD begins. This understanding may then lead to better targeted treatments to suit each person’s own needs or even prevent the disorder before it causes harm.

Join a Study

What are Clinical Trials?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including PTSD. During clinical trials, treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Please Note: Decisions about whether to apply for a clinical trial and which ones are best suited for a given individual are best made in collaboration with your licensed health professional.

How do I find Clinical Trials at NIMH on PTSD?

Doctors at NIMH are dedicated to mental health research. The studies take place at the NIH Clinical Center in Bethesda, Maryland and require regular visits. After the initial phone interview, you will come to an appointment at the clinic and meet with one of our clinicians. Find NIH-funded studies currently recruiting participants with PTSD by using ClinicalTrials.gov  (search: PTSD).

How Do I Find a Clinical Trial Near Me?

To search for a clinical trial near you, you can visit ClinicalTrials.gov . This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial’s purpose, who may participate, locations, and phone numbers to call for more details. This information should be used in conjunction with advice from health professionals.

Learn More

Free Booklets and Brochures

You can download or order free copies of the following booklets and brochures in English or en Español:

Multimedia

  • Watch: Dr. Daniel Pine on Boosting Resilience to PTSD: Dr. Daniel Pine on a NIH study that tracked Israeli soldiers through deployment to ID predictors. Study found that soldiers preoccupied with threat at the time of enlistment or with avoiding it just before deployment were more likely to develop post-traumatic stress disorder (PTSD).
  • For more videos, visit PTSD – Multimedia.

Federal Resources

Research and Statistics

Treating PTSD with headphones and sound waves gains supporters

Treating PTSD with headphones and sound waves gains supporters

Interview with The Dove

Interview with the Three Star

Sleep is the New Status Symbol

Sleep in the New Status Symbol – Read Article Here

VA suicide hotline still plagued with problems, IG finds

Despite change in leadership and promises to address ongoing problems with its veteran suicide line, nearly 30 percent of calls to the Department of Veterans Affairs were redirected to outside emergency centers, according to an inspector general report released Monday.

“We found that [Veterans Crisis Line] staff did not respond adequately to a veteran’s urgent needs during multiple calls to the VCL and its backup call centers,” the report said.

When the VCL program was started in 2007, VA management initially estimated that approximately 10 percent of calls would be rolled over to a backup center.

In fact, call rollover to backup centers increased between April and November 2016, peaking at more than 108,000, or a 28.4 percent rate.

In November, calls to the backup centers hit a peak of nearly 18,000 – a nearly 35 percent rollover rate.

In February 2016, the IG issued a report detailing how some suicide calls were being sent to voicemail or callers did not always receive immediate assistance from VCL and/or backup center staff.

The IG then called for the department to implement seven separate recommendations, but as of December 16, 2016 none were in place, Monday’s report said.

House Committee on Veterans’ Affairs Chairman Phil Roe, M.D. (R-Tenn.) expressed frustration, saying it is “unacceptable that issues with the Veterans Crisis Line have still not been addressed.”

Communications Director Tiffany McGuffee Haverly told Fox News the committee will hold a hearing April 4 to examine ongoing issues with the Veterans Crisis Line.

Sen. Johnny Isakson, R-Ga., chairman of the Senate Committee on Veterans’ Affairs, echoed Roe’s reaction to the IG report.

“The findings in this latest report identify an unacceptable disconnect between the Clinical Advisory Board and the Veterans Crisis Line in obtaining the clinical input necessary to make policy decisions. The Veterans Crisis Line should be collaborating with clinical services every step of the way,” he said in a statement.

Amanda Maddox, spokesperson for Isakson, told Fox News the committee was “informed by the inspector general that they do not believe there is a need for legislation. Our committee is currently looking into additional oversight options as well.

The IG also reported that management had not set any standards for the length of wait times when a veteran calls.

“We found that VCL leadership had not established expectations or targets for queued call times or thresholds for taking action on queue times. A veteran could be queued for 30 minutes, for example, and that wait time might not be reflected in hold time data; however, the result of the delay is the same, whether the veteran was in a queue or on hold,” the IG said.

The IG also criticized the absence of sustained and permanent leadership at the VCL, which functioned without a director for 10 months in 2015 before a permanent replacement was named.

But that director resigned in June 2016 and as of December 2016, no permanent director has been hired. Furthermore, supervisory staff did not identify the deficiencies in their internal review of the matter.

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