HospitalInspections.org

Based on hospital policy review and staff interview, it was determined the hospital failed to ensure a clear process for employees to enter, track, respond to, and report patient complaints and grievances. Misidentification of grievances as complaints had the potential to result in missed opportunities for patients' grievances to be entered, tracked, responded to, and reported for follow-up by hospital staff. Findings include:

An ICU RN was interviewed on 9/17/19, beginning at 2:11 PM. When asked if she understood the difference between a patient complaint and a patient grievance, the RN stated, "complaints are something I would try to fix first. If the complaint could not be fixed, it would be entered into QSTATIM [hospital incident report program] for supervisor review."

An ICU/MS QTM was interviewed on 9/17/19, beginning at 2:20 PM. When asked if she understood the difference between a patient complaint and a patient grievance, the QTM stated, "complaints, grievances, and incident reports are entered into QSTATIM. Complaints have to do with patient care and grievances deal with doctors or mistakes." Additionally, the QTM stated she was unsure if all complaints and grievances would be entered into QSTATIM, "it depends on what the issue is; hard to know the 'what-ifs.'"

An ED RN was interviewed on 9/17/19, beginning at 2:34 PM. When asked if he understood the difference between a patient complaint and a patient grievance, he stated, "the difference is between the patient's story and how they are feeling about the situation." The RN explained that if a patient had a complaint, he would hand them a card which included the hospital's complaint hotline. He stated he did not enter complaints or grievances into QSTATIM.

A hospital policy "Patient Grievance," effective 1/18/19, was reviewed. The policy did not include a process for hospital staff to provide complaint cards to patients and/or enter patient complaints and grievances into the QSTATIM program. It was unclear what uniform steps hospital staff should take in response to entering, tracking, responding, and reporting patient complaints and grievances.

The Director of Risk Management was interviewed on 9/17/19, beginning at 2:42 PM, and the hospital's grievance policy and staff interviews were reviewed in his presence. He confirmed the hospital's grievance policy was unclear and confirmed there was no uniform steps hospital staff should take in response to entering, tracking, responding, and reporting patient complaints and grievances.

The hospital failed to ensure a clear process for employees to enter, track, respond, and report patient complaints and grievances.

Based on medical record review, hospital policy review, document review, and staff interview, it was determined the hospital failed to ensure its grievance process included patient referrals to a QIO and failed to ensure compliance with QIO instructions for 1 of 1 patient (Patient #4) who filed an appeal with a QIO, and whose record was reviewed. This had the potential for unresolved patient issues regarding patients' quality of care and/or premature discharge. Findings include:

The Executive Director of Quality was interviewed on 9/16/19, beginning at 1:17 PM. When asked if the hospital maintained a log for patient appeals to a QIO, she stated, "no." She stated, to her knowledge, the hospital had only 1 appeal to a QIO in the last several years. The Executive Director of Quality stated this appeal was filed recently involving an individual identified as Patient #4. She stated Patient #4's appeal and record had not yet gone to UR for a formal review, as the patient discharged less than a month ago. The Executive Director of Quality stated a meeting to discuss Patient #4's appeal and UR review was scheduled for 10/09/19.

Patient #4 was a 60-year-old male who was admitted to the hospital on 8/15/19, with an admitting diagnosis of respiratory failure. Additional diagnoses included metastatic cancer and hypoxia. He was discharged home with hospice on 8/25/19.

Patient #4's medical record included a "Consult to Hospice" order, dated 8/25/19, signed by a physician, which stated, "Pt desires home with hospice."

Patient #4's medical record included a "Social Services Consultation," dated 8/25/19, signed by the LSW, which stated, "This morning I met with [Patient #4] and family. They wanted to go home with [hospice agency]. I called the nurse [name] with hospice to let her know about the admit. She was with another patient and would be able to meet the patient at their house between 1 and 130 [sic]. I let her and [name] the [hospice administrator] know that he was on 2L of O2, and taking oxycodone and ativan for anxiety and air hunger. I let [name] know the family was really anxious and wanted to make sure all the supplies would be there for when he got home. [Patient #4] heart rate became high and I called the nurse to see if she could meet them anytime earlier at their house. I went in to talk to family and [Patient #4] and asked if they could [sic] like to stay here at the hospital or go home to have pt die there. [Patient #4's daughter] wanted pt to stay in the hospital but son who is the POA and [Patient #4] wanted to go home. The nurse [name] with [hospice agency] then said she could meet at 1220 to their house. She said she stopped at the office to get supplies and medication and will be at the house shortly."

Patient #4's medical record included a discharge order, dated 8/25/19, signed by a physician, which stated, "home with hospice."

Patient #4's medical record documented he was discharged on 8/25/19, and was transported home on hospice care via ambulance.

The UR RN was interviewed on 9/17/19, beginning at 10:26 AM, and Patient #4's medical record was reviewed in her presence. The UR RN stated Patient #4 and his POA requested he be discharged home on hospice, however, his daughter disagreed and filed a discharge appeal with the hospital's QIO on Friday, 8/23/19. She stated the QIO requested Patient #4's medical records for appeal review on 8/23/19, however, their request was sent to an incorrect phone voicemail which was not identified by administration until Monday, 8/26/19, 3 days after the appeal was filed.

The Executive Director of Quality provided a letter from the hospital's QIO regarding Patient #4's appeal, dated 8/27/19, which stated "According to the [QIO] physician's review of the medical record, ending services is not appropriate based on the findings noted below: This decision was made because the [QIO] received insufficient medical records or other necessary documents within the required time frame."

A hospital policy "Patient Grievance," effective 1/18/19, was reviewed. The policy did not include a mechanism for timely referral of patient concerns regarding quality of care or premature discharge to the appropriate QIO. It was unclear how the hospital's grievance process addressed patient appeals to a QIO.

The Executive Director of Quality and Director of Risk Management were interviewed together on 9/17/19, beginning at 3:30 PM. They confirmed Patient #4's appeal to the hospital's QIO was not completed due to the fact the QIO's request for documentation was missed. The Director of Risk Management confirmed the hospital's grievance process did not include a mechanism for timely referral of patient concerns regarding quality of care or premature discharge to the appropriate QIO. They confirmed the hospital did not have a uniform process to ensure patient appeals to a QIO were identified, processed, and addressed.

The hospital failed to ensure its grievance process included a mechanism for timely referral of patient concerns regarding quality of care or premature discharge to the appropriate QIO.