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Based on clinical record review and staff interview, the facility failed to appropriately coordinate care and effectively implement their own policies and procedures for discharge planning to include timely initiation of discharge planning, communication with other health care providers involved in the care of the patient and an assessment of the availability of appropriate services to meet identified needs following hospitalization for 1 of 4 sampled patients (#5) as evidenced by: the facility did not identify from their ED (Emergency Department) records that the patient lives in an ALF (Assisted Living Facility) prior to the hospital admission; discharge planning was not started with the patient until the day prior to discharge. The patient was hospitalized for 3 days. No evidence was found to indicate that a return to the ALF was discussed with the patient or that other healthcare providers were contacted based on identified needs to coordinate care prior to discharge; and no evidence was found to indicate an attempt was made to contact ALF personnel regarding the possibility of the patient returning to the facility. The Hospital, arranged transportation to take the patient to a drop-off site where persons are picked up and taken to a homeless shelter.

The findings include:

Clinical record review for patient #5 reveal the patient went into the facility's ED via Ambulance on 01/07/11. The ED triage documentation documents the following: the patient came from a Halfway House, where facility staff called Emergency Medical Services because the patient wasn't "acting right." Medications the patient is on at home includes Dilantin and Risperdal; the chief complaint is altered mental status; medical history provided by records from another care provider or facility; present living situation nursing home/ALF. The patient was admitted from the ED to the hospital.

The 01/07/11 nursing admission assessment documents that the patient's history was provided by the patient, and the patient lives alone and "no discharge needs were assessed." Nursing behavioral health assessments from 1/7/11 through 1/10/11 document the patient is disoriented to time, but speech and affect are appropriate.

A 01/08/11, a physician consultation note documents that the patient is disoriented to time and place, but is fully conscious with normal language and speech.

A SW (social worker) note on 01/09/11 documents that the patient is alert and oriented, states he is homeless, has no family or friends to stay with and wants to go to a shelter. The SW documented that contacts were made and transportation was arranged.

A case management note on 01/10/11 documents that the case manager met with the patient. The patient was alert and oriented x 3 and stated that he wanted to go to a shelter. The case manager documented calling the Homeless Outreach Program and was instructed to have the patient dropped off on a street corner in a another local city that morning at 11:30 AM, where he would be picked up and taken to a shelter.

Nursing notes indicate that the hospital was not able to arrange the patient's medications and transportation in time to meet the scheduled pick up for the homeless shelter at 11:30 AM. Nursing documentation on 01/10/11 at 12:11 PM indicates that a nurse spoke, via phone, with a person on the Homeless Help Line and arranged for the patient to be "dropped at another location." The patient left the hospital via Ambulance transportation at 12:26 PM on 1/10/11.

A telephone interview was conducted by the surveyor with a local police officer on 01/20/11 at 1:30 PM, who stated the Broward County Outreach was contacted and the patient was not registered with the center and the patient was classified as a missing person.

On 01/20/11 at 1:50 PM, a request was made for the hospital to provide the EMS (emergency medical services) run report and facility transfer form that the patient came in with, as it was not located in the clinical record. The Risk Manager stated that the hospital had to call EMS to get the run report because EMS does not always leave the report at the hospital when the patient is brought in.

The Ambulance run report was received on 1/20/11 at 3:00 PM and does list the address where the patient was picked up and classifies the facility as a boarding/rooming house. No transfer form from the ALF to the hospital was found.

Review of the hospital's policy and procedure for discharge planning reveals the following:
* Discharge planning is initiated by the interdisciplinary team of physicians, nurses, case managers, social workers, patients and their families/significant others and other health care professionals that are involved in the patient's care;
* The objectives of discharge planning include to identify as early as possible, through screening and assessment, patients who are most likely to require assistance with discharge planning, ideally on or before the patient's admission; to develop an appropriate discharge plan with patients and their families/significant others, that considers the medical, bio-psychosocial, spiritual, financial and environmental needs of the patient utilizing available resources to meet their individual needs.

Based on clinical record review and staff interview, the facility failed to appropriately coordinate care and effectively implement their own policies and procedures for discharge planning to include timely initiation of discharge planning, communication with other health care providers involved in the care of the patient and an assessment of the availability of appropriate services to meet identified needs following hospitalization for 1 of 4 sampled patients (#5) as evidenced by: the facility did not identify from their ED (Emergency Department) records that the patient lives in an ALF (Assisted Living Facility) prior to the hospital admission; discharge planning was not started with the patient until the day prior to discharge. The patient was hospitalized for 3 days. No evidence was found to indicate that a return to the ALF was discussed with the patient or that other healthcare providers were contacted based on identified needs to coordinate care prior to discharge; and no evidence was found to indicate an attempt was made to contact ALF personnel regarding the possibility of the patient returning to the facility. The Hospital, arranged transportation to take the patient to a drop-off site where persons are picked up and taken to a homeless shelter.

The findings include:

Clinical record review for patient #5 reveal the patient went into the facility's ED via Ambulance on 01/07/11. The ED triage documentation documents the following: the patient came from a Halfway House, where facility staff called Emergency Medical Services because the patient wasn't "acting right." Medications the patient is on at home includes Dilantin and Risperdal; the chief complaint is altered mental status; medical history provided by records from another care provider or facility; present living situation nursing home/ALF. The patient was admitted from the ED to the hospital.

The 01/07/11 nursing admission assessment documents that the patient's history was provided by the patient, and the patient lives alone and "no discharge needs were assessed." Nursing behavioral health assessments from 1/7/11 through 1/10/11 document the patient is disoriented to time, but speech and affect are appropriate.

A 01/08/11, a physician consultation note documents that the patient is disoriented to time and place, but is fully conscious with normal language and speech.

A SW (social worker) note on 01/09/11 documents that the patient is alert and oriented, states he is homeless, has no family or friends to stay with and wants to go to a shelter. The SW documented that contacts were made and transportation was arranged.

A case management note on 01/10/11 documents that the case manager met with the patient. The patient was alert and oriented x 3 and stated that he wanted to go to a shelter. The case manager documented calling the Homeless Outreach Program and was instructed to have the patient dropped off on a street corner in a another local city that morning at 11:30 AM, where he would be picked up and taken to a shelter.

Nursing notes indicate that the hospital was not able to arrange the patient's medications and transportation in time to meet the scheduled pick up for the homeless shelter at 11:30 AM. Nursing documentation on 01/10/11 at 12:11 PM indicates that a nurse spoke, via phone, with a person on the Homeless Help Line and arranged for the patient to be "dropped at another location." The patient left the hospital via Ambulance transportation at 12:26 PM on 1/10/11.

A telephone interview was conducted by the surveyor with a local police officer on 01/20/11 at 1:30 PM, who stated the Broward County Outreach was contacted and the patient was not registered with the center and the patient was classified as a missing person.

On 01/20/11 at 1:50 PM, a request was made for the hospital to provide the EMS (emergency medical services) run report and facility transfer form that the patient came in with, as it was not located in the clinical record. The Risk Manager stated that the hospital had to call EMS to get the run report because EMS does not always leave the report at the hospital when the patient is brought in.

The Ambulance run report was received on 1/20/11 at 3:00 PM and does list the address where the patient was picked up and classifies the facility as a boarding/rooming house. No transfer form from the ALF to the hospital was found.

Review of the hospital's policy and procedure for discharge planning reveals the following:
* Discharge planning is initiated by the interdisciplinary team of physicians, nurses, case managers, social workers, patients and their families/significant others and other health care professionals that are involved in the patient's care;
* The objectives of discharge planning include to identify as early as possible, through screening and assessment, patients who are most likely to require assistance with discharge planning, ideally on or before the patient's admission; to develop an appropriate discharge plan with patients and their families/significant others, that considers the medical, bio-psychosocial, spiritual, financial and environmental needs of the patient utilizing available resources to meet their individual needs.