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Based on medical record review and interview for 1 (P#1) of 15 patients transferred from the ED to another hospital the facility failed to ensure the Authorization/Certification for Transfer documentation accurately identified the receiving hospital. The finding include:

Patient (P) #1 arrived in Hospital #1's ED on 7/23/18 at 10:42 PM with a chief complaint of abdominal pain and syncope after a fall at home. In addition P#1 was 23 weeks pregnant. P#1's evaluation consisted of physical examination, laboratory studies and radiologic studies. Vital signs were monitored and remained stable. Upon completion of evaluation the diagnoses of a large liver hematoma and HELLP syndrome (pregnancy related complication) was identified.

A decision was made to emergently transfer P#1 to Hospital #2 for a higher level of care because Hospital #1 did not have obstetrics or maternal-fetal medicine capabilities. The Transport Center at Hospital #2 was called by MD#2 and Hospital #2 accepted P#1. The Authorization/Certification for Transfer documentation in the medical record indicated P#1 was to be transferred to Hospital #2 and the receiving physician was MD#5.

A progress note by MD# 3 dated 7/24/18 at 3:26 AM identified that Hospital #2 called Hospital #3 indicating that they did not have a Neonatal Intensive Care Unit (NICU) bed and there was a potential for a patient (P#1) to be transfered from Hospital #1 to Hospital #3.

According to medical record documentation P#1 was evaluated stabilized and subsequently transferred to Hospital #3 not Hospital #2. However, the Authorization/Certification for Transfer document was not updated and/or accurate as it did not identify that P#1 was being transfered to Hospital #3.

MD#1 (Hospital #1) received a call from MD#3 (Hospital #3) for information pertaining to P#1. MD#1 reported that a radiologic report showed P#1 had a 17 cm. subcapsular hematoma of the liver. MD#3 indicated he/she would make arrangements for the fetus and call the surgical team to alert them of the issues. MD#3 provided a recommendation to start P#1 on a Magnesium Sulfate drip prior to transport to Hospital #3 and provided MD#5's (Hospital #3) name as the accepting attending.

Five to ten minutes after P#1 departed Hospital #1, MD#3 (Hospital #3) called MD#1 (Hospital #1) and stated that Hospital #3 was unable to coordinate surgical consultation and that Hospital #3 could no longer accept P#1. MD#1 notified MD#3 that P#1 was already in route.

According to a progress note by MD#3 (Hospital #3) dated 7/24/18 at 3:26 AM subsequent to P#1 leaving Hospital #1, MD#3 received a call from Hospital #3's general surgery team and indicated the team felt P#1 should go to a level 1 trauma center such as Hospital #2. Hospital #3 unsuccessfully attempted to divert the transport team to Hospital #2. Hospital #3's blood bank, general surgery team, interventional radiology, nursing, labor and delivery and generalists were placed on standby pending the arrival of P#1. Patient #1 arrived at Hospital #3 on 7/24/18 at 1:00 AM, was stabilized. Hospital #2 was contacted and accepted P#1, who was transferred to Hospital #2 to receive a higher level of care at 2:26 AM. At the time of transfer, P#1 was identified as maternal fetal status was critical but stable.

A review and verification of events according to MD#1's medical record documentation was conducted with MD#1 on 7/30/18 at 1:30 PM. MD#1 indicated that after initially speaking with MD#3 (Hospital #3), he/she was under the impression that Hospital #3 was accepting P#1 under the care of MD#5.

During an interview with Hospital #1's Emergency Department Chief on 7/30/18 at 12:10 PM he/she indicated although patient evaluation, treatment and the severity of the transfer was MD#1's priority, a new transfer authorization form should have been completed with the name of the receiving facility and physician.

The Hospital Transfer policy indicated when the patient is to be transferred the receiving, hospital and physician must give acceptance in advance and the acceptance must be documented in the medical record. The name of the accepting practitioner must be documented. The policy indicated an Authorization of Transfer form is completed and signed by the patient/surrogate and physician.