HospitalInspections.org

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Based on interview, document review, and review of hospital policies and procedures, the hospital failed to develop and implement policies and procedures for transfer of patients to other facilities, in accordance with the Emergency Treatment and Labor Act (EMTALA).

Failure to ensure patients have been accepted by the receiving facility, and receiving medical provider with certification by the sending physician of the reason for transfer, patient condition, risks and benefits of the transfer, mode of transportation, and patient consent risks inappropriate transfer, delayed care, and poor patient outcomes.

Findings included:

1. The hospital failed to ensure that the receiving facility and receiving physician accepted the patient in transfer prior to Patient #26 leaving the Emergency Department on 08/10/23.

2. The hospital failed to ensure that the medical records for 3 patients transferred to other facilities included the Authorization for Transfer form required by hospital policies and procedures (Patient #12, Patient #17, Patient #26).

Cross Reference Tag A-2409
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ITEM #1: Transfer not accepted by the receiving facility and provider

Based on interview, document review and review of policies and procedures, the hospital failed to ensure that patients transferred to other facilities were accepted by the receiving facility and provider prior to leaving the hospital for 1 of 11 patients transferred.

Failure to ensure that patients have been accepted by the receiving facility and provider, risks inappropriate transfer, delayed care, and poor patient outcomes.

Findings included:

1. Document review of the hospital's policy titled, ""Application Of And Compliance With The Emergency Medical Treatment And Active Labor Act (EMTALA)," number 1800, effective 07/20/22, showed that if the hospital determines that it does not have appropriate medical and/or staffing resources to properly stabilize the patient, transfer to an appropriate facility may be made if a physician certifies in writing that the medical benefits of the transfer are expected to outweigh the risks of transfer. When a patient is transferred the consent of the receiving hospital to accept the transfer must first be obtained and documented in the medical record, and that the physician or qualified medical personnel overseeing the transfer must certify in writing on a certification form. The certificate will state the reason for transfer, patient condition, benefit/risks of transfer, receiving hospital, mode of transportation, and patient consent.

2. Medical record review showed that Patient #26 arrived in the Emergency Department (ED) on 08/10/23 at 8:01 PM with pain and swelling of the right testicle. The ED physician note dated 08/10/23 at 8:04 PM, showed that the patient had pain that had worsened since the injury and now was severe. The note showed that the physician considered the possibility of testicular torsion or testicular hematoma. The provider note showed that the patient required emergent ultrasound of the right testicle and scrotum due to the possible torsion. The physician called Providence St. Mary Medical Center, but there was no urology coverage. He then called Kadlec Regional Medical Center at 8:18 PM but was told the physician was not available and would call back as soon as possible. The note showed that there was no return call within a reasonable time and since time may be of the essence, he asked the patient to drive himself to Kadlec ER for further evaluation, to not eat or drink anything. The note showed that the patient understood that failure to follow the instructions could lead to loss of testicle or infertility. The provider note showed that the physician to physician call occurred at 8:40 PM when the provider called Kadlec's ED directly [instead of calling through the transfer center] (Patient #26).

3. Medical record review showed that a nursing note dated 08/10/23 at 8:14 PM showed that the patient was being transferred to outside facility, due to no urology services. The patient's departure time was documented as 8:23 PM (Patient #26).

4. On 08/31/23 at 2:20 PM, during an interview with the investigator, the Assistant Director of Nursing (Staff #1) stated that the patient left the hospital before being accepted by the receiving hospital or the receiving physician (Patient #26).

ITEM #2: Transfer documentation

Based on interview, document review, and review of hospital policies and procedures, patients transferred to other facilities did not have documentation on the Transfer Form as required by hospital policy for 3 of 11 patients transferred.

Failure to ensure that patients have completed documentation prior to being transferred to another facility risks inappropriate transfer, delayed care, and poor outcomes.

Findings included:

1. Document review of the hospital policy titled, "Application Of And Compliance With The Emergency Medical Treatment And Active Labor Act (EMTALA)," number 1800, effective 07/20/22, showed that if the hospital determines that it does not have appropriate medical and/or staffing resources to properly stabilize the patient, transfer to an appropriate facility may be made if a physician certifies in writing that the medical benefits of the transfer are expected to outweigh the risks of transfer. When a patient is transferred the consent of the receiving hospital to accept the transfer must first be obtained and documented in the medical record, and that the physician or qualified medical personnel overseeing the transfer must certify in writing on a certification form. The certificate will state the reason for transfer, patient condition, benefit/risks of transfer, receiving hospital, mode of transportation, and patient consent.

2. Medical record review showed that there were no Authorization for Transfer forms (known as Transfer Forms) located in 3 of 11 records of patients transferred to other facilities (Patient #12, Patient #17, Patient #26).

3. On 08/31/23 at 2:40 PM, during an interview with the investigator, the Assistant Director of Nursing (Staff #1) stated that there were 3 records of patients that were transferred that were missing the Transfer Forms (Patient #12, Patient #17, Patient #26).

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