HospitalInspections.org

Based on document review and interview, it was determined that for 2 of 5 patients (Pts. #1 & #7), the Hospital failed to ensure patients who were potentially exposed to COVID-19 were provided discharge instructions related to COVID-19.

Findings include:

1. On 10/7/2020, the Hospital's policy titled, "Discharge of a Patient," last approved 6/16/2020, was reviewed. The policy required, "F. Discharge planning addresses the following issues, as clinically indicated: 5. Medical issues... 6. Warning signs and symptoms that may indicate the need to see immediate medical/psychiatric attention..."

2. On 10/13/2020, the Hospital's policy titled, "Use and Disclosure of Protected Health Information and Personally Identifiable Information," last approved on 2/21/2020, was reviewed. Pages 13 and 15 included, "Patient Authorization Not Required... 7. Disclosures for Public Health Activities. The System [Hospital] may disclose PHI [personal health information] for public health activities to... d. A person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, in accordance with applicable Infection Control and Employee Health policies..."

3. On 10/7/2020, Pt. #1's clinical record was reviewed. Pt. #1 was admitted to the Psychiatric Hospital Generational Services Unit (GSU) (Geriatric Psychiatry) on 8/3/2020, with the diagnosis of major depressive disorder. Pt. #1's history and physical, dated 8/4/2020, included that Pt. #1 had been admitted for depression and "physical aggressive threat toward family".

- Pt. #1's physician's order for a SARS-COV-2 by PCR (GeneXpert) [COVID-19] test was ordered on 8/11/2020. The lab test was completed on 8/11/2020 at 6:30 AM, with results reported on 8/11/2020 at 9:23 AM, "SARS-COV-2 (COVID-19) - GeneXpert: not detected."

- Pt. #1's physician discharge order was dated 8/13/2020 at 9:47 AM and included that medication management would continue with Pt. #1's Hospital Psychiatrist (MD #1) with a follow-up visit on 8/17/2020 at 3:15 PM, and out-patient therapy was scheduled for 8/18/2020 at 2:00 PM. Pt. #1's nursing discharge note, dated 8/13/2020 at 12:05 PM, included, "[Pt. #1's] mood is calm and pleasant upon discharge ... verbalizes understanding of all discharge instructions ..." There was no instruction on COVID-19 exposure.

4. On 10/7/2020, Pt. #5's clinical record was reviewed. Pt. #5 was admitted on 8/5/2020, with a diagnosis of cognitive disorder. Pt. #5 had a COVID-19 test at a Medical Hospital on 8/5/2020, which was negative. Pt. #5 developed a cough, fever, and was tested for COVID-19 on 8/10/2020 at 10:24 PM. Pt. #5 was placed in isolation. The result was positive for COVID-19, and Pt. #5 was transferred to a Medical Hospital on 8/11/2020 at 12:34 AM.

5. Pt. #1 had been discharged 2 days later on 8/13/2020 at 12:05 PM, after Pt. #5's positive COVID-19 test results were known. Pt. #1's discharge instructions did not include documentation regarding possible exposure to COVID-19. There was no documentation in Pt. #1's clinical record that Pt. #1's family had been notified of Pt. #1's possible exposure.

6. On 10/8/2020 at 8:45 AM, an interview was conducted with the Director of Nursing/Manager of GSU (E #1). E #1 stated that Pt. #1 had been discharged prior to the meeting with the patients and staff on 8/13/2020, when all the patients and staff were notified regarding possible exposure to COVID-19. Pt. #1 was called at home regarding the COVID-19 exposure on 8/13/2020. Pt. #1's file was closed after discharge, so documentation of the phone call was not completed.

7. Pt. #1's "Telephone Encounter" note, dated 8/14/2020, to Pt. #1 included, "Patient states received a call from [Hospital] yesterday stating that she was exposed to COVID positive patient and to contact Primary Care Physician for testing to be done in 5 - 7 days. Patient has had several COVID test - last on 8/11/2020 - negative. Patient states she was not given any details from [Hospital] except that another test was needed."

8. On 10/8/2020, Pt. #7's clinical record was reviewed. Pt. #7 was admitted on 8/5/2020, to the GSU with a diagnosis of neurocognitive disorder with behavioral disturbances, had tested negative for COVID-19 on 8/5/2020 and on 8/10/2020. Pt. #7 had been discharged back to a Nursing Facility on 8/12/2020, without symptoms. The Nursing Facility called the Hospital on 8/13/2020 to inform the Hospital that Pt. #7 had tested positive for COVID-19.

-The discharge summary dated 8/12/2020, included, "Hospital Course: Over the course of the hospitalization patient [Pt. #7] participated in and was treated via the following modalities...group therapy."

-The clinical record lacked documentation that Pt. #7's family and the receiving long term care facility were notified of Pt. #7's exposure to COVID-19 while in the Facility.

-The clinical record lacked documentation of recommendations to self quarantine for 14 days due to COVID-19 exposure while in the Facility.

-The post discharge COVID-19 test results, dated 8/14/2020, documented that Pt. #7 tested positive for COVID-19.

9. On 10/7/2020 at 2:00 PM, an interview was conducted with a Licensed Clinical Professional Counselor (E #3). E #3 stated that COVID-19 discharge instruction was not done because this is a Psych Hospital, not medical, and most geriatric patient go to other Facilities, not home.