HospitalInspections.org

Based on record review and interview the hospital failed to document an appropriate discharge plan for each patient including discussion with the patient and the patient's representative .
This deficiency is evidenced by:
1) failure to provide an appropriate discharge plan in 1 ( #2) of 5 (#1- #5) discharged patients reviewed; and
2) failure to document notification of the patient's support person of changes in the discharge plan in 1 (Pt #2) of 5 (#1- #5)) discharged patients sampled.
Findings:

1) Failure to provide an appropriate discharge plan.

Review of hospital policy POC-17, "Discharge Planning," revised 7/2022 revealed in part, "Hospital discharge planning is a process that involves determining the appropriate post-hospital discharge destination for a patient, identifying what the patient requires for a smooth and safe transition from the hospital to his/her discharge destination; and beginning the process of meeting the patient's identified post-discharge needs."

Medical record review revealed Patient #2 was involuntarily admitted with an Coroner's Emergency Certificate (C.E.C.) on 07/12/2022 at 11:49 a.m. with a diagnosis of adjustment disorder and suicidal ideation.

Review of the discharge planning for Patient #2 revealed he had previously lived in a therapeutic group home. That group home was refusing re-placement after discharge because he had been violent. Placement for Patient #2 using the New Opportunities Waiver (NOW) from the Louisiana Office Of Citizens with Developmental Disabilities (OCDD) could not be established prior to expiration of the C.E.C. Plans were made to extend his hospitalization through a formal voluntary admission (FVA) until placement could be found, but Patient #2 refused to sign the voluntary admission. Patient #2 insisted on discharge to a homeless shelter near his grandmother's home.

Review of the discharge care plan prepared by S7LPC revealed Patient #2 was discharged on 07/26/2022 at 10:00 a.m. He was transported via medicaid transport to a homeless shelter in Lafayette, Louisiana.

Review of the grievance filed on 08/04/2022 by the grandmother of Patient #2 revealed he was dropped off at a closed homeless shelter.

On 08/10/2022 at 9:15 a.m. the surveyor called the shelter and verified the shelter had been closed since June 2020.

In interview on 08/10/2022 at 9:20 a.m. S3RM verified Patient #2 was dropped off at a closed shelter.

2) Failure to document notification of the patient's support person of changes in the discharge plan.

Review of hospital policy POC-17, "Discharge Planning," revised 7/2022 revealed in part, "D. The continuing care plan must address the following:...11. Documentation that the continuing care plan in its entirety is discussed with the patient or caregiver."

Review of the consents for Patient #2 revealed on 07/13/2022 the patient had authorized the release of the information to his grandmother.

Review of the discharge planning for Pt. #2 revealed the hospital was unable to find placement for Patient #2 using his NOW waiver through the Louisiana Office of Citizens with Developmental Disabilities (OCDD) prior to expiration of the Coroner's Emergency Certificate (C.E.C.). Patient #2 refused to sign a formal voluntary admission (FVA) and requested discharge to a homeless shelter.

Further review of the discharge planning revealed S6LPC did contact the grandmother of patient #2 on 07/25/2022, the day prior to expiration of the C.E.C. S6LPC notified the grandmother of Patient #2's decision to be discharged to a homeless shelter. S6LPC asked the grandmother to speak to Patient #2 about signing the FVA to allow time for appropriate placement through the New Opportunities Waiver (NOW) program. The documentation did not include the name or location of the homeless shelter.

On 07/26/2022 at 10:00 a.m. Patient #2 was discharged on expiration of the C.E.C. He was transported via medicaid transport to a homeless shelter in Lafayette, Louisiana.

In interview on 08/09/2022 at 9:57 a.m. S3RM verified the grandmother of Patient #2 had been active in the discharge planning process and there was no documentation the grandmother of Patient #2 was given the name or address of the homeless shelter when the discharge plan plan changed.

Based on record review and interview the hospital failed to document transfer of all necessary medical information pertaining to the patient's course of illness and treatment, post-discharge goals of care, and treatment preferences, at the time of discharge, to the appropriate post-acute care service providers for 1 (#2) of 5 (#1- #5) discharged patients sampled.

Findings:

Medical record review revealed Patient #2 was involuntarily admitted on 07/12/2022 at 11:49 a.m. with a diagnosis of adjustment disorder and suicidal ideations.

Review of the Discharge Care Plan revealed the patient was discharged to a homeless shelter in Lafayette, Louisiana. Post-discharge mental health care was arranged with a provider in Lafayette and S7LPC indicated the records for Patient #2 had been transferred.

On 08/10/2022 at 9:39 a.m. the surveyor called the outpatient mental health provider to inquire about the appointment and the transfer of records. The outpatient mental health provider had no documentation that an appointment had been scheduled for Patient #2 and reported the facility had not recieved Patient #2's records.

In interview on 08/10/2022 at 11:38 a.m. S3RM verified the hospital had no documentation to verify the appointment had been scheduled and no documentation of the sucessful transfer of the recoords for Patient #2..