HospitalInspections.org

Based on policy review, medical record review and interview, the hospital failed to implement a discharge plan to address post hospitalization needs for a patient treated for a suicidal attempt and major depression and failed to provide adequate notice of anticipated discharge for 1 of 3 (Patient #2) sampled patients.

The findings included:

1. Review of the hospital "Discharge Plan" policy implemented 7/17/2019 revealed, "The development of a Discharge Plan begins on admission. As a component of the assessment process, treatment recommendations are formulated that include plans for discharge. The patients demonstrated readiness for discharge should be linked to the achievement of inpatient treatment goals, although some longer term goals may be continued following hospital discharge...The longer term goals may not be accomplished completely by the time of discharge...The's goals should reflect the expectation for the patients highest level of functioning and may include recommendations for continued treatment and/or follow up on an outpatient basis...The Discharge Plan may include but not be limited to recommendations that: prepare the patient an/or family/significant others for the transition to the next level of care, define instructions about continued treatment...include timely and direct communication with and transfer information to other programs, agencies, or individuals that will be providing continuing care...One of the best predictors of sustained response to treatment is compliance with treatment after discharge. The Discharge Plan should take into account the continuation or completion of those treatments which were generated in the current level of care and the initiation of those treatments which were needed but were deferred to another phase of treatment. A. The treatment plan shall include documentation of the recommended follow up appointment that typically should occur within 7 days of discharge. If the follow up appointment is not able to occur within 7 days of discharge, then documentation shall be made on the Discharge Plan form or in the inpatient record explaining the delay in follow up..."

2. Medical record review for Patient #2 revealed a 16 year old female who was admitted to the hospital after a suicide attempt by hanging with a belt. Patient #2 was admitted to the hospital on 10/10/2022 with a primary diagnosis of Major Depressive disorder and determined to have a high suicide risk. Patient #2 was provided individual, family and group therapy services, along with medication management at the hospital.

On 10/11/2022 the discharge planner documented, "CM [case manager] spoke with client's mother to obtain discharge information. Mother stated client will return home once discharged. Client has no current MH [mental health] provider..." The discharge planner documented Patient #2's primary care physican and preferred pharmacy information.

Review of the initial treatment plan dated 10/10/2022 revealed the initial discharge plan included: Return to previous living arrangements and Outpatient therapy with psychiatrist and/or therapist. Review of the treatment plan update dated 10/17/2022 revealed "Discharge Planning Issues: None with disposition secure to parents w/ [with] aftercare services..." The treatment plan update did not specify what type of aftercare services were indicated for Patient #2. There were no other care plan updates from 10/17/2022 until Patient #2 was discharged on 10/21/2022.

Review of family therapy session note by Therapist #1 dated 10/18/2022 revealed a future planned therapy session for 10/26/2022 with Patient #2 and her parents.

Review of a case management note, by the Director of Utilization Review, dated 10/21/2022 at 2:31 PM revealed, "Contacted guardian [named Patient #2's mother] to inform her of discharge being set for today due to patient being stable and no longer meeting medical necessity to remain acute. Aftercare appointment was scheduled for 10/25/2022 at 3 PM with [named Primary Care Physican] for med [medication] management and therapy..."

Review of the "Transition Record" completed by the Director of Utilization Review, revealed Patient #2 was being discharged home with her mother and had a scheduled follow up appointment with her Primary Care Physican (PCP). There were no scheduled appointments for mental health or psychiatric services.

3. In an interview on 1/24/2023 at 1:45 PM, the Director of Utilization Review [UR] verified she documented the discharge because the physican set the discharge. When asked why Patient #2 and her mother were given a same day notice of discharge, the Director of UR stated, "Like I said, the doctor makes that decision." When asked to provide the documentation from the Physican regarding the discharge on 10/21/2022, she stated "There is no doctors note...sometimes he does a verbal order or by text message..." The Director of UR further stated, "I am not the discharge planner...evidently the discharge planner was out that day [10/21/2022]. The Director of UR verified she made Patient #2 an appointment with her PCP but did not make a mental health provider appointment.

In an interview on 1/24/2023 at 1:58 PM, Therapist #1 she verified she had scheduled another family session for 10/26/2022 and was not aware of any planned discharge for Patient #2.

In a subsequent interview on 1/24/2023 at 2:00 PM, the Director of UR stated the private insurance for Patient #2 had denied any further hospital days on 10/21/2022 and a UR Coordinator contacted Physician #1 who initiated the discharge order for 10/21/2022.

In an interview on 1/24/2023 at 2:26 PM, the Discharge Planner stated she was not certain why she was not working on 10/21/2022, when Patient #2 was discharged. The Discharge Planner stated if a patient/parent reports upon admission that they have no current mental health provider, she makes a note, which alerts her to reach back out to the parent/guardian prior to discharge ask what mental health provider they prefer for follow up services. The Discharge Planner stated, "I always make sure they have a mental health appointment when they [patients ] discharge...I didn't implement the appointment for Patient #2...I must have been out that day..." The Discharge Planner stated the Director of Utilization Review was trained on how to conduct discharges and to make the appropriate follow up appointments.

In an interview with the Chief Executive Officer (CEO) and Risk Manger on 1/24/2023 at 3:25 PM, the CEO verified the expectation was to provide parents with adequate notice prior to discharge and same day notice was not the expectation. The CEO stated a follow up appointment should have been made for mental health/medication management follow up services as part of the discharge planning.

In a telephone interview on 1/25/2023 at 9:25 AM, Patient #2's PCP office representative verified the office did not provide any mental health counseling and did not have a Psychiatrist on staff.