HospitalInspections.org

Based on findings at A2407, the facility failed to ensure compliance with Code of Federal Regulations (CFR) 489.24.

Based on record review, interview and document review, the facility failed to ensure it provided all recommended services to stabilize an emergency medical condition for 1 of 58 patients (Patient #22).

Findings include:

In the early morning hours of 1/19/2024, Patient #22 was transferred from hospital #1 with an authorization and consent for transfer form. The diagnosis was corneal foreign body. The documented reason for the transfer was the patient needed a higher level of care hospital #1 could not provide. The service recommended, which was unavailable at hospital #1, was ophthalmology. Hospital #2 had ophthalmology services on call. The patient was transported via ambulance to hospital #2.

Hospital #1's emergency department removed some corneal foreign body(ies), but it was unable to remove a visible foreign body at the 5 'o'clock position adjacent to the pupil. Hospital #2's emergency department was able to remove this visible foreign body, and the patient reported mild improvement in symptoms. The patient's vital signs were stable and within normal limits. The patient was diagnosed with corneal abrasion and corneal foreign body with a prescription for Erythromycin Base to be applied 5 times daily in each eye. The patient was given an outside referral to two ophthalmologists, neither of which was located on or near the hospital campus.

There was no documented evidence the emergency provider attempted to contact the available on call ophthalmology service for an opinion.

The patient was discharged at 6:38 AM on 1/19/2024. The following discharge instructions were provided to the patient: You were seen in the Emergency Department for evaluation of a foreign body in your eye. We removed at least a portion of this foreign body. I am unable to tell if we completely removed all the pieces of metal. You need to follow-up with an ophthalmologist for a more thorough evaluation than we are capable of doing here in the Emergency Department. I have given the phone number for (ophthalmologist). [No phone number was documented in the instructions, and a request for a copy of the actual discharge instructions was met with "these are the discharge instructions" from the Emergency Department Director]. Discharge instructions continued: Please call their office immediately to schedule an appointment, ideally this morning. You received 1 dose of Erythromycin eyedrops which is an antibiotic. You will need additional antibiotics as you have a residual corneal abrasion regardless of if there is remaining metal in your eye.

On 7/12/2024 at 8:40 AM, the Emergency Department Associate Chief Medical Officer indicated the purpose of the transfer was to remove the visible metal shaving noted, and the other metal shavings could remain in the eye 3-4 days and be followed up. The provider made the decision to discharge for the follow-up.

The transfer document revealed the purpose of the transfer was a higher level of care, availability of ophthalmology service, which was not consulted.

The emergency department provider documented the patient needed to follow-up with an ophthalmologist immediately, ideally that morning, for a more thorough evaluation than the emergency department was capable of, despite choosing not to contact the available on-call ophthalmology service.

There was no assistance from the emergency department or assurance if or when the patient could secure an ophthalmology appointment within 3-4 days.