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Based on interview and document review, the facility failed to provide safe discharge planning for 1 of 5 minor patients (P1) when P1 was discharged to the main office building of a youth outreach organization. This resulted in an immediate jeopardy (IJ) for P1 when the hospital discharged him without services.

The immediate jeopardy (IJ) began on 11/15/24, when P1 was discharged to the main office building of a youth outreach organization with no services for youth available at that location. On 12/6/24 at 12:15 p.m. hospital president, vice president of patient care services, director of nursing for the emergency department, senior patient safety specialist, social work manager, manager of accreditation and regulatory compliance, and senior patient safety specialist were notified of the IJ.

As a result, the hospital was found NOT in compliance with the Condition of Participation discharge Planning at
§482.43

A condition level deficiency was issued. See A0813 for additional information.

Based on interview and document review, the facility failed to provide safe discharge planning for 1 of 5 minor patients (P1) when P1 was discharged to the main office building of a youth outreach organization without any services or supports. This resulted in an immediate jeopardy (IJ) for P1 when the hospital discharged him to this location.

Findings include:

P1's Psychiatric Consultation dated 11/2/24 indicated P1 presented to the emergency department (ED) 11/1/24 following a suicide attempt. P1 ran into traffic and was struck by a vehicle. P1 was boarded in the ED, awaiting inpatient adolescent psychiatry for safety and further assessment. The note continued to indicate long-term, P1 would benefit from specialized mental health services for trauma and intellectual disability. P1's diagnoses included autism, development language disorder, disruptive mood dysregulation disorder, mild intellectual disability, and post-traumatic stress disorder.

P1's psychiatric provider note dated 11/12/24 indicated P1 refused to return to his group home. P1 stated he had been physically abused at the group home, and would kill someone or kill himself if he was forced to return.

P1's psychiatric progress note dated 11/14/24 indicated P1 continued to have episodic elevated behavior/agitation. Plan was to discharge P1 to the community having exceeded any therapeutic benefit of emergency department/acute hospital setting. P1 needed a strict behavioral plan, and psychosocial interventions to address his symptoms.

P1's social work note dated 11/15/24 indicated P1's county mental health supervisor asked for P1 not to be discharged, and leadership from P1's county workers wanted to speak with hospital leadership. Hospital leadership was not available. P1 was discharged via cab to a "youth shelter."

P1's psychiatric progress note dated 11/15/24 indicated P1 was discharged to a "shelter." P1 needed long-term residential treatment. "It is unsustainable to keep the patient in the ED."

P1's discharge summary dated 11/15/24 indicated key discharge instructions included take medications as prescribed.

P1's adolescent psych bed call list dated 11/2/24 through 11/12/24, indicated P1 had been declined (at some facilities multiple times), at all inpatient adolescent mental health units available in Minnesota and Wisconsin for reasons including aggression, need for high level of care, and no beds available.

The hospital's list of adolescent youth homeless shelters contacted for P1 and dated 11/14/24, indicated multiple shelters were contacted with no beds available. The name of the community organization P1 was discharged to was not on the list.

P1's cab ride receipt dated 11/15/24 indicated P1 was transported from the hospital at 11:03 a.m. to the main office building of a youth outreach organization arriving at 11:29 a.m.

On 12/4/24 at 9:28 a.m., P1's county worker (CW)-A stated P1 was extremely impulsive. P1 needed staff to assist him with daily needs like food and medication administration. He functioned at a much lower level than a normal 17-year-old. A request was made to the hospital not to discharge P1 on 11/15/24 as planned, because a bed would be available at an in-patient child and adolescent behavioral health hospital early the following week.

On 12/4/24 at 12:01 p.m., registered nurse (RN)-A stated she was uncertain if P1 had the knowledge to self-administer medication, and no assessment or education was provided to P1 about medication administration prior to discharge. She did not speak up about P1's discharge to the shelter because the staff were told there was no other place for him to go. She thought the shelter would be a place for him to get food and sleep.

On 12/4/24 at 12:14 p.m. social worker (SW)-A stated a shelter would be contacted to secure a bed before an adolescent would be discharged to a shelter. A day program could be part of the plan, but it was not a discharge location.

On 12/4/24 at 2:34 p.m. SW-B stated P1 was discharged to a drop-in center that had daytime programing, but was not a place P1 could sleep. It would be up to P1's guardians to find him a place to sleep that night. SW-B's progress note identified P1 was discharged to youth shelter.

On 12/5/24 at 10:07 a.m., medical doctor (MD)-A stated they did not feel hospitalization was beneficial to P1. There was no clinical indication to keep him in the hospital. P1 needed a structured setting with consistent staff, but the hospital could not find a bed for him. The day program was preferable for him.

On 12/5/24 at 10:32 a.m., SW-C stated a county worker had informed the hospital social worker that the county was trying to get P1 admitted to an in-patient child and adolescent behavioral health hospital, but there was no date provided before P1 was discharged from hospital. When discharging a minor patient to a youth shelter, a social worker would call the shelter to secure a bed before discharging the patient.

On 12/6/24 at 10:49 a.m. P1's legal guardian (G)-A stated she had asked the hospital to not discharge P1 because there would be a bed for him at a child and adolescent behavioral health hospital early the following week. After P1 was discharged, G-A received a phone call from the day program who informed her that P1 was at their main office. G-A confirmed the address P1 was picked up from was the main office building of a youth outreach organization. This location did not provide a place to sleep, recevie food or services needed.

On 12/6/24 at 11:15 a.m., the youth outreach center worker (OCW)-A stated P1 just showed up at the main office building of their youth outreach organization without any communicaiton from the hospital. OCW-A confirmed P1 was sent to their office building with no services provided to youth. P1 had utilized services at a different location within the organization in the past, so they contacted P1's legal guardian who sent someone to pick him up.

The undated facility Patient Discharge Policy directed patient care needs, including, but not limited to psychosocial care, physical care, treatment, and services needed after discharge is to be addressed by the interdisciplinary care team.

The IJ was removed on 12/12/24 when the hospital had submitted and implemented an acceptable removal plan. Facility discharge policy was updated to include assessment of availability of necessary community supports or resources, likelihood of the patient needing post-hospital services, and to determine appropriateness of patient's ability to access basic care needs. Facility patient discharge procedure was updated to include minors cannot be discharged until parent or legal guardian is informed of and in agreement with the discharge plan. If a parent or guardian can't be reached, the interdisciplinary team will reassess DC plan. Also added was, in the case of minors, the disposition location must be contacted and confirm acceptance of the patient incoming arrival. Education was started for all nursing, provider and social work staff involved in discharges. This was verified through interview and document review.