HospitalInspections.org

Based on interviews with hospital staff, record reviews, and review of the hospital's policies and procedures, the facility failed to implement it's own discharge planning policies and procedures for 2 of 10 patients (Patients #2 and #3) reviewed for discharge planning. This affected Patient #3 who had a history of dementia and was discharged without arrangements for transportation. This also affected Patient #2 who was not believed to be homeless until days prior to hospitalization and was expected to need assistance with self care after discharge, but her discharge planning did not include an assessment of available financial and social support resources. This resulted in a potentially avoidable delay of her discharge by 4 days before she left without appropriate placement and without a confirmed plan to meet her daily needs and follow up care.

The findings include:

1) Review of Patient #3's hospital record revealed he was an 82 year old with a history of dementia who lived at home, had a history of irregular heart rate, and had been admitted to the hospital on 04/03/16 with chest pain that had been intermittent since he had passed out and fallen less than a week prior. His "Initial Discharge Planning Assessment" completed on 04/03/16 showed he was expected to return home upon discharge at which time the person he lived with would pick him up.

Further review of Patient #3's hospital "Discharge Assessment" dated 04/04/16 showed he was discharged on 04/04/16, but could not get someone to pick him up so the nurse walked him to the main entrance where he called for a cab and said he would wait for the cab to arrive. There was no documentation that Patient #3 was picked up by the cab company.

During an interview with RN "A" on 04/13/16 at 1:45 pm, RN "A" admitted she accompanied Patient #3 onto the staff elevator and, believing he was alert and oriented and had called a cab on his cell phone, left him on the 1st floor to await his ride.

Review of the hospital's Policy "Discharge Planning and Process, NS-10-906" documents "All patients being discharged from nursing units, including patients leaving against medical advice, (excluding those being transferred by ambulance), are taken to their waiting transportation in a wheelchair by trained personnel (transporter or volunteer) and are assisted as necessary. If leaving by private car, it is necessary to see that they enter the car safely. If a patient refuses wheelchair assistance, document in EMR (electronic medical record) and MIDAS (computer entry)."

During an interview with the Chief Nursing Officer, on 04/13/16 at 4:23 pm, she stated staff should see a discharged patient get into the car.

During further interview with Registered Nurse "A" on 04/14/16 at 11:43 am, RN "A" admitted she never knew that it was a hospital policy for patients going home by private auto to be seen safely into the vehicle upon discharge.

2) During review of the hospital's grievances related to discharge planning, a grievance was disclosed pertaining to Patient #2. Review of Patient #2's hospital record showed she was admitted on 03/07/16 for a fractured pelvis and left the hospital on 03/14/16.

Review of Patient #2's "Discharge Planning Notes" dated 03/08/16 showed Patient #2 confirmed she was homeless and that Patient #2 reported she fractured her hip while trying to move furniture into a truck to go live in another state. The same discharge planning note showed the Social Worker discussed a plan for Patient #2 to go to an Assisted Living Facility, upon discharge and Patient #2 was agreeable to this. There was no evidence in the Discharge Planning Notes that Patient #2 was asked about her financial resources or social/community support.

Further review of Patient #2's "Discharge Planning Notes" throughout her stay showed evidence that only one placement option, was attempted for her and, even after discharge orders were noted to be given on 03/11/16, there was no evidence of communication to inquire about resources Patient #2 might have in order to arrange for her needed assistance after discharge. On 03/14/16 at 11:39 am, the Social Worker documented on a "Discharge Planning Note" that she notified Patient #2 there was still no bed available for her at an Assisted Living Facility and Patient #2 said she could not wait any longer and planned to leave that day "to make hotel arrangements" from money she had saved. A Nurse Notes dated 03/14/16 at 12:30 pm showed Patient #2 was no longer in her room and her belongings were gone. There was no indication in the nurse's notes that Patient #2 received her discharge instructions, prescriptions for medication, or was aware that she was to follow up with an orthopedic surgeon for x-rays in 4 weeks.

Review of the hospital's Policy and Procedure "Scope of Assessment, NS-12-050" documented under Procedure: At a minimum, the social assessment will include the following:
... 2. Support systems- the formal and informal resources available to the patient i.e., family, friends and community organization.
3. Financial evaluation- patient's ability to meet his needs given his present financial status.

During an interview conducted with Social Worker "B" on 04/14/16 at 3:30 pm, SW "B" stated she does not ask homeless people about their finances.