HospitalInspections.org

Based on policy and procedure review, medical record review, staff and medical staff interviews the acute care facility (ACF) failed to follow their policy regarding a completed EMTALA transfer consent form for 1 (P19) of 4 sampled transfer medical records. This failed practice has the potential to affect all patients who require transfer from the ACF. According to facility provided information the Emergency Department (ED) transfers an average of 285 patients per month.

See citation A2409, that also resulted in A2400 to not be met.

Findings include:

A. Review of facility policy "Examination, Treatment, and Transfer of Individuals Who Come to the Emergency Department -(EMTALA)- (St. Francis)," approved 2/2023 revealed, "stable for transfer means: the physician determines within reasonable medical probability that the individual will sustain no material deterioration in the patient's medical condition as a result of transfer. When the hospital transfers an individual with an EMC to another facility, the transfer will be carried out in accordance with the following procedures: the hospital will send to the receiving facility a copy of the completed applicable sections of the Transfer Consent Form."

B. Review of P19's medical record revealed, P19 presented to the ACF-A on 10/19/2022 at 5:46PM via ground ambulance which was diverted to ACF-A 23 miles enroute from CAH-A to ACF-B during an interfacility transfer of the patient, pregnant at 29 weeks gestation with an EMC of profuse vaginal bleeding (pregnant woman bleeding a lot putting mom and baby at high risk). The original plan was for P19 to transfer from CAH-A via ground ambulance 120 miles to ACF-B for acute respiratory distress (not able to breathe or maintain oxygen levels to live). Review of the "ED Provider Notes" from ACF-A revealed, in part, "Patient is requiring 100% nonrebreather [oxygen therapy] in order to keep her oxygen level satisfactory" and that "as she was being transferred...she began having significant profuse vaginal bleeding and subsequently got diverted to our facility." After consultation with its on-call OB/GYN specialist, ACF-A determined P19 was "no longer actively bleeding" and a "helicopter was summoned to properly take the patient to [ACF-B]." The "clinical impression" included "respiratory distress," and Physician-A performed 45 minutes of "critical care" for "respiratory failure" prior to transfer.

Review of ACF-A's EMTALA Transfer Consent form signed by Physician-A 10/19/2022 at 7:57PM revealed P19 condition listed as "stable patient," when intubation (a tube placed in the airway), ventilation (machine to breathe for the patient) and sedation (medication induced coma) was required at 8:41PM by the flight crew prior to air transfer at 9:40PM, and only one risk of transfer, "decompensation," despite the ACF-A form states, "must be patient-specific diagnosis."

C. During an interview on 4/3/2024 at 9:39AM, RN-A revealed that the EMTALA transfer consent form in P19's medical record was the most recent version.

During an interview on 4/3/2024 at 3:09PM, Physician-A revealed, the decision to intubate P19 was requested by transport crew to secure the airway prior to transfer. "I called the Maternal Fetal Medicine (MFM) (specialized physician to care for a high risk pregnant patient and baby) to update on patient status with change of condition since accepting the patient." [The ACF-A EMTALA transfer consent form lacked evidence of the updated patient condition, and risks of transfer for P19.]

Based on policy and procedure review, medical record review, staff and medical staff interviews the acute care facility (ACF) failed to properly list the unstable patient condition and risk of transfer on the EMTALA transfer form for 1 (P19) of 4 sampled transfer medical records. This failed practice has the potential to affect all patients who require transfer from the ACF. According to facility provided information the ED transfers an average of 285 patients per month.

See citation A2400, that also resulted in A2409 to not be met.

Findings include:

A. Review of facility policy "Examination, Treatment, and Transfer of Individuals Who Come to the Emergency Department -(EMTALA)- (St. Francis)," approved 2/2023 revealed, "stable for transfer means: the physician determines within reasonable medical probability that the individual will sustain no material deterioration in the patient's medical condition as a result of transfer. When the hospital transfers an individual with an EMC to another facility, the transfer will be carried out in accordance with the following procedures: the hospital will send to the receiving facility a copy of the completed applicable sections of the Transfer Consent Form."

B. Review of P19's medical record revealed, P19 presented to the ACF-A on 10/19/2022 at 5:46PM via ground ambulance which was diverted to ACF-A 23 miles enroute from CAH-A to ACF-B during an interfacility transfer of the patient, pregnant at 29 weeks gestation with an EMC of profuse vaginal bleeding (pregnant woman bleeding a lot putting mom and baby at high risk). The original plan was for P19 to transfer from CAH-A via ground ambulance 120 miles to ACF-B for acute respiratory distress (not able to breathe or maintain oxygen levels to live). Review of the "ED Provider Notes" from ACF-A revealed, in part, "Patient is requiring 100% nonrebreather [oxygen therapy] in order to keep her oxygen level satisfactory" and that "as she was being transferred...she began having significant profuse vaginal bleeding and subsequently got diverted to our facility." After consultation with its on-call OB/GYN specialist, ACF-A determined P19 was "no longer actively bleeding" and a "helicopter was summoned to properly take the patient to [ACF-B]." The "clinical impression" included "respiratory distress," and Physician-A performed 45 minutes of "critical care" for "respiratory failure" prior to transfer.

Review of ACF-A's EMTALA Transfer Consent form signed by Physician-A 10/19/2022 at 7:57PM revealed P19 condition listed as "stable patient," when intubation (a tube placed in the airway), ventilation (machine to breathe for the patient) and sedation (medication induced coma) was required at 8:41PM by the flight crew prior to air transfer at 9:40PM, and only one risk of transfer, "decompensation," despite the ACF-A form states, "must be patient-specific diagnosis."

C. During an interview on 4/3/2024 at 9:39AM, RN-A revealed that the EMTALA transfer consent form in P19's medical record was the most recent version.

During an interview on 4/3/2024 at 3:09PM, Physician-A revealed, the decision to intubate P19 was requested by transport crew to secure the airway prior to transfer. "I called the Maternal Fetal Medicine (MFM) (specialized physician to care for a high risk pregnant patient and baby) to update on patient status with change of condition since accepting the patient." [The ACF-A EMTALA transfer consent form lacked evidence of the updated patient condition, and risks of transfer for P19.]