HospitalInspections.org

Based on record review, policy review and staff interview it was determined that the facility failed to ensure that the policy regarding patient discharge from the Emergency Department (ED) was followed for 3 (#1, #5, #6) of 10 sampled patients. This practice does not ensure a safe discharge.

Findings include:

The facility's policy "Discharge from the Emergency Department" #ER05005, last reviewed 8/10 required that a complete set of vital signs be obtained prior to discharge. In addition, patients who are chemically impaired are to be assessed for level of consciousness at the time of discharge.

1. Patient #1 presented to the ED on 4/2/11. He received a medical screening examination and was diagnosed with seizure disorder, anxiety and alcohol intoxication. The patient's blood alcohol was 458. The physician noted that the patient was stable and ready for discharge at approximately 9:00 p.m. The patient remained in the ED until approximately 12:30 a.m. on 4/3/11. The medical record revealed that the patient's healthcare surrogate took the patient home. A repeat blood alcohol at 11:30 p.m. revealed the level was still elevated at 311. Review of nursing documentation at the time of discharge revealed only the temperature was assessed. There was no documentation of the other vital signs and no documentation of the patient's level of consciousness.

The ED nurse manager was interviewed on 5/13/11 at approximately 10:00 a.m. She stated that the patient remained in the ED until 12:30 a.m. in order to receive the intravenous fluids that were ordered and had to wait until the healthcare surrogate arrived to take him home.

2. Patient #5 presented to the ED on 4/5/11 at approximately 9:17 p.m. with the chief complaint of weakness. The patient received a medical screening examination and was determined to be stable for discharge by the physician at 12:40 a.m. on 4/6/11. Review of nursing documentation revealed the patient's blood pressure was not recorded at the time of discharge as required by the facility's policy.

3. Patient #6 presented to the ED on 5/2/11 with the chief complaint of change in mental status. The patient received a medical screening examination and was discharged at 1:59 p.m. Review of nursing documentation revealed the the nurse documented only the patient's temperature.

The nurse manager who was present during the record reviews on 5/13/11 confirmed the above findings.