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Based on record reviews and interviews, the hospital failed to accept an appropriate patient transfer for which the hospital had the capacity and capability to provide the stabilizing treatment required by the patient's condition. This deficient practice was evidenced by failure to accept a patient transfer (Patient #2) from the transferring hospital Emergency Department's physician who had requested OMFS services for 1 (Pt #2) of 20 (Pt# 1-20) sampled patient records.

Findings:

Review of the hospital's policy titled "Treatment and Transfer of Individuals Requesting/In Need of Emergency Medical Services" revealed in part, to the extent that the hospital has specialized capabilities or facilities not available at the requesting facility, acceptance of transfers is appropriate if the hospital has the capacity and capability to treat the patient.

Review of the hospital's Adult Trauma LERN Region 2 and 3 trauma acceptance guidelines revealed in part, our goal is to accept all Region 2 trauma requests no matter what our capacity is. This includes trauma that does not meet trauma activation criteria, (ex: stable traumatic head bleed). Capacity Red: Request must come through LERN. We are no longer are required to call the trauma surgeon for acceptance of requests that do not meet activation criteria. Notify an ER physician of acceptance. Exceptions to LERN Region 2 auto-acceptance: call the trauma surgeon for acceptance for facial trauma that does not meet trauma activation criteria and if a hospital has orthopedics and is calling for an isolated fracture on a stable patient with no other injuries, call the trauma surgeon for acceptance. Capacity Green: it is not required for a Region 2 hospital to call LERN to be accepted. Instead, call the ER physician for acceptance.

Review of the hospital's self-report to State Office revealed on 05/16/2023 at 4:00 a.m. hospital B contacted hospital A transfer center for a transfer request for facial trauma. Hospital A transfer center nurse denied the request because OMFS was not on call, and hospital A was at capacity. LERN then called hospital A bed coordinator. LERN was notified that hospital A transfer center nurse had denied Patient #2 already due to no OMFS. LERN stated it was for C1 fracture and facial fractures, but they would continue looking elsewhere for acceptance. Upon review, while hospital A was at capacity, hospital A identified that the hospital did have OMFS availability at the time of the transfer request of Patient #2.

Review of the hospital's facial trauma call roster revealed on 05/16/2023 an ENT physician was on-call.

In an interview on 05/30/2023 at 2:55 p.m. S3RN stated she took a call from hospital B requesting for OMFS services for facial trauma. S3RN stated she told hospital B that hospital A did not have OMFS on call. S3RN stated the misunderstanding was not knowing that ENT or plastics covered facial trauma and the transfer was denied.

In an interview on 05/31/2023 at 8:34 a.m. S2HM stated hospital B called hospital A for acceptance of Patient #2 and acceptance was denied by hospital A.

In an interview on 05/31/2023 at 8:47 a.m. S1SDR stated even though hospital A was at capacity, hospital A should have accepted the transfer. S1SDR stated you treat the patient and then worry about where you will put the patient after the doctor assessed the patient.

In an interview on 05/31/2023 at 9:00 a.m. S1SDR stated the facial trauma physician roster is a blend of plastics and oral surgery. S1SDR stated on 05/16/2023 ENT was on call for facial trauma.

Review of Patient #2's medical record from hospital B revealed Patient #2 arrived in the emergency department on 05/16/2023. Review of the emergency room note revealed Patient #2's diagnoses were altered mental status, fall, orbital floor fracture, hypokalemia, nondisplaced C1 fracture, and right internal carotid artery occlusion. Further review revealed Patient #2 was transferred to hospital C for higher level of care/facial trauma.