HospitalInspections.org

Based on record review and interview the Facility failed to ensure that specific discharge plan requirements are met on 1(one) out of 5 sampled patients (SP#1).

The findings include:

Review of clinical record conducted on 02-15-10 of sample patient (SP) #1, subject of investigation (CCR#2010000450), revealed that the patient is a 48 year old female with a history of hypertension, diabetes , chronic obstructive pulmonary disease, and schizoaffective disorder with complaints of exacerbation of symptoms. SP#1 was admitted to the hospital and was started on psychiatric treatment and daily psychotherapy. The patient continued to exhibit positive paranoid disorganized thoughts that were inappropriate. The patient responded well to treatment as well as continued on previous medications for the patient ' s previous history of diabetes and hypertension. The patient seemed stable with no suicidal ideation was ordered discharge to home in fair and improved condition on 11-19-09.Further review of record revealed that the patient was awake, alert, and oriented to person , place, and time. SP#1 psychiatric evaluation on 11-16-09 revealed that he/she has the mental capacity to give express and informed consent for admission/treatment. SP#1 had signed and received copy of patient ' s rights and responsibilities and patient ' s grievance procedure. Review of SP#1 discharge instructions on 11-19-09 revealed that he/she received instructions from the hospital social worker about how to follow up appointments with the doctor and further assistance for major medical needs. SP#1 also received instructions for transportation to the pharmacy to pick up medications then to Broward Outreach Shelter at 2056 Scott Street, Hollywood FL 33022. The Social Worker also noted that the shelter was notified thru shelter intake coordinators prior to discharge from the hospital.
Interview with the Discharge Planner/Social Worker conducted on 02-15-10 at 11:45am confirmed above discharge instructions to SP#1. He/she stated that the SP#1 was ambulatory with steady gait. He/she also stated that he/she notified Broward Outreach Shelter prior to SP#1 discharge from the hospital but cannot recall what was the response of one of the intake coordinators from the shelter. The hospital Social Worker claimed he/she left a message with the other intake coordinator but did not do any follow up call to ensure that SP#1 was discharged appropriately.
Review of the Hospital Grievance Log conducted on 02-15-10 revealed an incident on 11-19-09 regarding SP#1 in a form of a letter from the Joint Commission. The letter dated 11-23-09 was regarding a complaint from the CEO Task Force For Ending Homelessness, Inc.. The complaint summary showed: " On November 19, 2009 at approximately 16:00 hours, a 58 year old disabled adult named SP#1 was delivered to a parking lot of a defunct church by a taxi cab. Hospital staff discharged SP#1 , paid a taxi to dump the patient at the Homeless Outreach pick-up location in a parking lot in Fort Lauderdale. SP#1 cannot read or write, does not know her Social Security number and cannot remember the address of the facility where she lives. The discharge papers say that the patient is being discharged to the Broward Outreach Shelter in Hollywood Florida and that SP#1 was given multiple telephone numbers to contact to secure permanent shelter, set appointments for doctors and psychiatric appointments - tasks that SP#1 is not capable of doing. I called Broward Outreach Shelter because the discharge document stated that the hospital Social Worker spoke to the two Intake workers at the shelter. I spoke to the head Intake Counselor who told me that neither she nor the other intake counselor ever received a call from anyone at the hospital and that she had sent SP#1 and the taxi back to the hospital earlier during the day when they tried to dump the patient on the shelter steps. SP#1 was dumped in a parking lot in a part of town known for drugs and violence, left with strangers, confused and scared. "
Review of the Hospital response to The Joint Commission (TJC) conducted on 02-15-10 revealed that the hospital did the investigation and follow up actions of the complaint regarding SP#1. The hospital determined that the staff were making discharge arrangements with inaccurate and incomplete knowledge of community resources and referral processes for homeless patients. Further review of the hospital response to TJC revealed the actions made by the hospital to ensure proper and safe discharge of patients to Outreach Program Shelters.
Interview with the Vice President of Quality Management conducted on 02-15-10 at 3:00pm confirmed above findings.