HospitalInspections.org

Based on document review and interview the Quality Care Coordination team failed to ensure services performed under a contracted service were provided effectively for one (1) of ten (10) patients. (Patient # 10)

Findings include:

1. The hospital policy titled, Discharge Planning, Policy/Procedure number PCS-D, indicated the Quality Care Coordination (QCC) Team may be contacted to assist in meeting the patient's discharge needs. The QCC team will assist in discharge planning. Changes in the patient condition would be reflected in changes in the discharge plan. This policy was last reviewed in 12/2022.

2. The hospital policy titled, Paramedic Program Operational Guidelines, Policy/Procedure number CM 3.2, indicated the paramedic performs assessments, education on disease management/medication management, and evaluates compliance with the plan of care for appropriate post discharge patients in an effort to reduce readmission. The Paramedic Program provides post discharge care and secondary prevention for optimal outcomes across the continuum of care. This policy was last revised in 2022.

3. Review of the contract titled, Mobile Integrated Healthcare Agreement, indicated the goal of the mobile integrated healthcare program was to reduce hospital readmissions and improve patient health for high-risk patients. The service will provide paramedics specially trained in outpatient community services for follow up for thirty (30) days with patients recently discharged from the hospital. After the patient is referred to the program, the paramedic will conduct a formal home assessment. At each patient contact, the paramedic will complete an assessment. This agreement was dated 04/01/2016.

4. Review of patient # 10's medical record (MR) indicated the following:
a. Patient was discharged from the Emergency Department (ED) on 01/13/2023 at 2:55 pm with the understanding he/she would be part of the Paramedic Program. MR documentation indicated the patient verbalized understanding of the discharge instructions and plan. The patient was informed the paramedic would check on him/her at home. S # 1's (Paramedic) notes dated 01/16/2023, 01/17/2023 and 01/18/2023, indicated that he/she had phoned the patient to schedule a paramedic home visit and left a message with their contact information.
b. Patient was discharged from the ED on 01/21/2023 at 10:28 pm. The MR documentation indicated the Paramedic Program would continue to try and facilitate helping the patient. S # 1's note dated 01/27/2023, indicated that he/she had phoned the patient to schedule a paramedic home visit and left a message stating a paramedic would be out to his/her house Tuesday 01/31/2023 around 8:00 am for a follow up. Requested a return phone call. S # 2 (Paramedic) note dated 01/31/2023, indicated phoned to confirm paramedic home visit today. Due to inability to confirm the appointment it was canceled. Left voicemail with contact information.
c. Patient returned to ED on 01/30/2023.

5. In interview on 02/21/2023 at approximately 1:30 pm with administrative staff member A # 6 (QCC Team Lead Case Manager), confirmed that when the paramedics are not able to reach the patient post discharge, he/she would follow up with APS (Adult Protective Services) to file a report and also do a wellness check to ensure the patients safety. A # 6 confirmed that he/she was unaware that the patient had not been seen by the paramedics post discharge and that he/she did not follow up with a wellness check after the 01/13/2023 and/or 01/21/2023 discharges.

6. In interview on 02/21/2023 at approximately 2:10 pm with administrative staff member A # 5 (QCC Team Manager), confirmed he/she was aware that the patient had not been seen by the paramedics post discharges (01/13/2023 and 01/21/2023). A # 5 confirmed he/she should have followed up with a wellness check for the patient but did not.

7. In interview on 02/21/2023 at approximately 2:20 pm with administrative staff member A # 1 (Vice President Patient Care Services/Chief Nursing Officer), confirmed we should have called for a welfare check.