HospitalInspections.org

Based on review of the Hospital's 3/30/13 Emergency Department (ED) Log and interviews, it was determined that Hospital failed to record data in the ED log related to Patient #1's 3/30/13 ED presentation.

Findings include:

Please see tag A2406 for information regarding Patient #1 and his/her 3/30/13 presentation to the Hospital ED.

The Surveyor interviewed Case Manager #3 at 11:15 A.M. on 5/21/13. Case Manager #3 said she was paged to the ED Waiting Room where she encountered Patient #1, two Emergency Medical Technicians, one of Patient #1's sons, and one of Patient #1's sisters. Case Manager #3 said the Family indicated Patient #1 should not have been discharged and that Patient #1 was supposed to be admitted to the psychiatric service at Hospital #2 (another campus of the Hospital System) once his/her medical issues were cleared up.

Case Manager #3 said she told the Family Patient #1 was deemed safe for discharge and that their current options were to go through ED Triage or to take Patient #1 to the ED at Hospital #2 where the Hospital System's psychiatric services were located. Case Manager #3 said she believed Patient #1 was taken to the ED at Hospital #2.

The Hospital's 3/30/13 ED Log did not include Patient #1's name or the fact that he/she did not receive a medical screen examination prior to being directed to Hospital #2.

Based on interviews, review of documentation related to 26 patients presenting to the Hospital's Emergency Department during the time period of 1/3/13-5/14/13 and a review of Medical Staff Bylaws, Rules and Regulations, it was determined that:
1.) the Hospital failed to provide a medical screening examination (MSE) to 1 of the 26 patients (Patient #1 on 3/30/13).
2.) Medical Staff Bylaws, Rules and Regulations did not specify the individuals qualified to conduct MSEs at the Hospital.

Findings include:

1.) Discharge Instructions, dated and signed by Patient #1 on 3/30/13, indicated Patient #1 was discharged home following a 4-day hospitalization for severe hypothyroidism (inadequate levels of thyroid hormone), mild kidney failure and bipolar disorder (a psychiatric disorder). The Discharge Instructions indicated Patient #1 would have nursing and physical therapy home care services and was to make follow-up appointments with his/her primary care physician and psychiatrist.

A Nursing Shift Summary, dated 3/30/13, indicated Patient #1 said he/she did not have a way to get home and a chair van was arranged for 1:30 P.M.

A Nursing Event Note, dated 3/30/13, indicated that at approximately 2:00 P.M., the Chair Van Emergency Medical Technicians (EMTs) notified Registered Nurse (RN) #1 that Patient #1 did not have house keys and if they were unable to locate a family member, they would be returning Patient #1 to the Hospital. The Nursing Event Note indicated RN #1 informed the EMTs that Patient #1 was discharged and if Patient #1 was brought back to the Hospital, he/she would have to be brought the ED.

The Surveyor interviewed Case Manager #2 at 10:30 A.M. on 5/22/13. Case Manager #2 said that on the afternoon of 3/30/13, RN #1 informed her that Patient #1 was discharged home by chair van, but did not have house keys, and the EMTs were transporting him/her to the Hospital ED. Case Manager #2 said she notified the ED Case Manager (Case Manager #3) of Patient #1's impending arrival in the ED.

The Surveyor interviewed Case Manager #3 at 11:15 A.M. on 5/21/13. Case Manager #3 said Case Manager #2 notified her of Patient #1's impending arrival in the ED on 3/30/13. Case Manager #3 said Case Manager #2 also told her that one of Patient #1's sisters had been contacted (Sister A) and was upset that Patient #1 had been discharged and indicated the discharge was not a safe discharge.

Case Manager #3 said a short while after she spoke with Case Manager #2, she was paged to the ED Waiting Room where she encountered Patient #1, two EMTs, one of Patient #1's sons, and another of Patient #1's sisters (Sister B). Case Manager #3 the Family indicated Patient #1 should not have been discharged and that Patient #1 was supposed to be admitted to the psychiatric service at Hospital #2 (another Hospital System campus) once his/her medical issues were cleared up.

The Surveyor interviewed Sister B at 12:45 P.M. on 4/26/13. Sister B said Patient #1 should not have been discharged from the Hospital on 3/30/13. Sister B said Patient #1 was lethargic, could barely walk and could not think clearly.

Case Manager #3 said she told the Family Patient #1 was deemed safe for discharge and that their current options were to go through ED Triage or to take Patient #1 to the ED at Hospital #2 where the Hospital System's psychiatric services were located. Case Manager #3 said Patient #1 was alert, but did not participate in the conversation. Case Manager #3 said she believed Patient #1 was taken to the ED at Hospital #2. Case Manager #3 said she was not sure how Patient #1 was transported to Hospital #2.

Sister B said she transported Patient #1 to Hospital #2.

Patient #1 did not receive a MSE prior to being directed to Hospital #2.

2.) The Hospital's Medical Staff Bylaws, Rules and Regulations did not specify the individuals qualified to conduct MSEs.

The Surveyor interviewed the Hospital's ED Medical Director at 11:55 A.M. on 5/23/13. The ED Medical Director said MSEs are performed by ED Physicians and Obstetricians.