HospitalInspections.org

Based on review of facility documents and medical record (OTH1), and staff interviews (EMP), it was determined that the facility failed to accept from a referring hospital an appropriate transfer of an individual (OTH1).

Findings include:

Review of facility policy "Compliance-Emergency Medical Treatment and Active Labor Act(EMTALA)" dated 01/25/2010, revealed " ... III. Policy Definitions (if appropriate) Appropriate Transfer occurs when: ... (ii) the receiving facility has the available space and qualified personnel for the treatment of the individual ... Capabilities of a hospital means the physical space, equipment, supplies and services (e.g. ... intensive care ...) ... The capabilities of the hospital's staff mean the level of care that the hospital's personnel can provide within the training and scope of their professional licenses. Capacity means the ability of the Hospital to accommodate the individual requesting examination or treatment of the transferred individual. ... ."

1) Review of OTH1 dated 04/24/2010 01:34, revealed "Emergency Department Chart ... PER FORBES [EMP10] THE INTENSIVIST AT FORBES WILL NOT ACCECPT AN OUTSIDE TRANSFER. NEW ARRANGEMENTS ARE NOW BEING MADE ... "

2) Review of facility "Daily Census Report" dated 4/24/2010, revealed " ... ICU Max Capacity 18 Staffed Beds 8 Unit Census 8 ... ".

3) Review of facility documentation dated April 26, 2010, 8:45 AM, revealed " ... this patient was accepted to ICU at Forbes on Saturday AM. Someone then called [other facility ER] back and advised FRC [Forbes Regional Center] was closed to outside referrals??? ... "

4) A telephone interview with EMP10 on May 3, 2010, at 1:00 PM, revealed "At around 5:15 AM, I got a call from the [other facility Emergency Department] doctor stating there was a patient who was very ill, with sepsis and a bleeding problem. [The physician] asked me if I could accept the patient. I said yes, but our policy is to check with the intensivisit. Admissions to ICU (Intensive Care Unit) need approved by the intensivist. [The intensivist] thought that the patient was more complicated and needed more aggressive care than Forbe's could provide. I accepted the patient, but we would consult an intensivist, because I couldn't take care of someone that sick on my own. I'm pretty sure that only statement that was said was that the admission to the ICU would have to be approved by the intensivist. It was more that the intensivist on call wanted the proper care, what was best for the patient. The service that they needed was beyond our hospital."
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Review of facility policy "Direct Admission to Critical" dated 02/02/2010, revealed "I. Policy Statement If a patient arrives requiring direct admission to a speciality area and requires stabilization or monitoring until a bed is available, they will be admitted to the Emergency Department ... 4. ... The Intensivist notification will be initiated by the ED MD for all ICU patients. It is recommended that the Intensivist evaluate the patient in the ED prior to admission to a critical care bed."

Review of facility "Medical Staff Rules and Regulations" dated September 24, 2009, revealed "Article 8 ON CALL POLICY ... 8.2 Response to Call (a) When an on-call physician is contacted for an emergency situation and requested to respond, the physician must: 1) be reasonably available , by telephone, to the Hospital. ... 2) respond in person, if so requested, within a reasonable time period. Response in person is expected within 45 minutes. The on-site requesting physician, in consultation with the on-call physician, will determine whether the patient's condition requires the on-call physician to see the patient as soon as possible."

5) Interview on May 4, 2010, at 12:30 PM with EMP11 revealed "One of our hospitalist paged me and said there was a patient at [other facility] that needed transferred. I thought another option was needed because we do not have 24 hour coverage here. The best thing for that patient at that time would be to transfer where they have 24 hour coverage for the best care. [They] had a doctor at bedside in the ED and the other facility had 24 hour coverage onsite. I never spoke to that doctor (other facility ED physician) directly. I don't know who [they] talked with. I talked with the hospitalist. I thought I was doing the right thing by getting the patient the appropriate bed."