HospitalInspections.org

Based on review of policies and procedures and hospital documents and interviews with hospital staff, the hospital failed to follow its policies:
1. Concerning recipient hospital responsibilities. This occurred for one (Patient #23) of seventeen patients, whose medical records were reviewed and a request for transfer was received at the hospital.
2. Concerning maintenance of a completed central log.

Findings:

1. The hospital has developed policies that comply with the requirements for 42 CFR 489.20 and 489.24.

2. The hospital's EMTALA (Emergency Medical Treatment and Active Labor Act) - Transfer Policy, policy #11-47 with an effective date of 4/2010, requires that a "hospital with specialized capabilities or facilities ...shall accept from a transferring hospital an appropriate transfer of an individual with an emergency medical condition..." The hospital's EMTALA - Provision of On-Call Coverage, policy #11-43 with an effective date of 12/2011, specifies that the on-call physician is responsibility to be available and that "the emergency physician or other practitioner who has personally examined the individual and is currently treating the individual shall be controlling..."

On the evening of 07/31/2012, between 2240 and 2345, the hospital did not follow its policies and accept a request for transfer of a patient (Patient #23) with an emergency medical condition for which the hospital had the specialized capabilities.

3. The hospital's EMTALA - Central Log Policy, policy #11-47 with an effective date of 12/2011, stipulated, "The hospital will maintain a Central Log containing information on each individual who comes to the DED (dedicated emergency department) seeking assistance, whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged."

The hospital did not maintain a complete log. Reviewed on 08/23/2012, for the dates 08/01-29/2012, the log did not contain the dispositions (whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged) for each individual who presented to the hospital's DED each day for that time period.

Based on record review, policy and procedure review and staff interview, it was determined the hospital failed to ensure the emergency department log documented the discharge disposition for each patient who presented to the emergency department. Findings:

The hospital's EMTALA Central Log Policy, #11-47, with an effective date of December 2011, documented, "...The hospital will maintain a Central Log containing information on each individual who comes to the DED (dedicated emergency department) seeking assistance, whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged..."

The finalized hospital emergency room log was reviewed for August 2012. The log did not have documentation of patient discharge disposition on the following dates:

08/01/12 - one record
08/02/12 - two records
08/03/12 - three records
08/04/12 - two records
08/05/12 - four records
08/06/12 - four records
08/08/12 - one record
08/09/12 - two records

On 08/23/12, staff J was informed of the missing information on the emergency department log. She stated there needed to be better documentation and oversight of the emergency department log.

Based on review of medical records, hospital documents and other documents supplied to the surveyors, and interviews with hospital staff, the hospital failed to accept, from a referring hospital, an appropriate transfer of an individual who required the specialized capabilities and facilities of the hospital in one of seventeen medical records (Patient #23 of Patients #1 through 5, and 12 through 23) reviewed. On the date and time of the proposed transfer for one patient (Patient #23), the hospital had the capability and capacity to treat the individual.

Findings:

1. Patient #23 presented to the requesting emergency department (ER) on 07/31/2012 at 2115 with complaints of head trauma from an assault. According to the emergency room report from the requesting hospital, OU Medical Center (OUMC) in Oklahoma City, Oklahoma, was called at 2240 due to the requesting/sending ER physician's determination of a perceived active cerebral vascular bleed and that required neurosurgery emergency situation. OUMC was designated as the Level I and II Trauma facility for that day/night. The requesting hospital's ER physician documented that numerous calls were placed to OUMC in regard to transfer of Patient #23, and that both the neurosurgeon and hospitalist service refused acceptance of the transfer. The patient was finally accepted by another hospital and transferred to that third hospital.

2. The specialty on-call sheets for 07/31/2012 show the hospital had both neurosurgery and internal medicine on-call coverage.

3. According to the hospital's Divert Log, on the date and time of the requested transfer, the hospital was not on divert.

4. On the morning of 08/23/2012, Staff D confirmed that usually requests for transfer from other hospitals were handled in the hospital's Transfer Center. According to the Transfer Center's call log, on 07/31/2012 at 2240, a request for transfer was received from another hospital. The requested/needed service was neurosurgery. The log documented the request was "denied."

5. The Transfer Center's documentation form for Patient #23 recorded the neurosurgeon declined acceptance on 07/31/2012 at 2248 and the hospitalist/internal medicine declined acceptance at 2334. This was confirmed by telephone interview with Staff A on 08/23/2012 at 1545

6. Staff B told the surveyors on the morning of 08/24/2012 that she refused the transfer because she felt the patient did not need neurological surgery intervention and referred the requesting ER physician to the internal medicine services of the hospital.

7. Staff C, the physician on-call for internal medicine did not communicate with the surveyors and although given the opportunity, did not provide a written statement of the event.