HospitalInspections.org

Based on record review and interviews, the hospital failed to ensure Emergency Department (ED) nursing staff performed adequate patient discharge and hand-off procedures for patients returning to nursing home facilities.

ED nursing staff failed to notify the long-term-care facility staff on the discharge condition for two (Patient #1, and 2) of four patients discharged for the hospital ED between 02/10/19 and 05/02/19.


This failed practice had the likelihood to result in increased risk to patient safety due to the patient's treatment, condition, and transportation method not being communicated to the patient's nursing home care givers.

Findings:

Medical Record Review

Review of the medical records showed Patient #1 and #2 are the same patient with two different ED admission dates. The medical records for Patient #1 and #2 failed to show that the hospital staff had made contact with the nursing home following the patient's discharge.

A review of the record showed Patient #1 was brought to the hospital ED by Emergency Medical Services (EMS) on 02/10/19 at 8:37 am, the patient was transported from a long-term-care facility with a chief complaint of a painful gastrostomy tube (feeding tube).

The record showed the registered nurse (RN) assessed the patient at 8:37 am, and documented the patient arrived from a nursing home and wanted their feeding tube removed.

The physician documented at 8:48 am the patient was requesting the feeding tube to be removed. The record showed the physician advised the patient to see his oncologist the next day for removal of the feeding tube. The record showed at 9:55 am, the physician discharged the patient.

The record showed the RN discharged the patient a 10:17 am, provided discharge instructions, and the patient was wheeled to the hospital lobby to wait on a cab.

Patient #2 was brought to the hospital ED by EMS on 04/19/19 at 9:35 pm. The record showed the patient was transported from a long-term-care facility with a chief complaint of a dislodged gastrostomy tube (feeding tube).

The record showed the RN assessed the patient at 9:36 pm, and documented the removed the patient's feeding tube.

The physician documented at 10:06 pm the patient was no longer in active treatment for cancer and was not currently dependent on the feeding tube. The record shows the physician wrote a discharge order at 10:10 pm, and
the RN documented the physician discharged the patient, "discharged from ED by physician and not seen by RN".

Policy Review

A review of hospital policy titled "Discharge Planning: Patient Choice for Post-Acute Providers/Services (02/2018)" shows that the hospital will determine the appropriate post-hospital destination for the patient based on what the patient requires for a smooth safe transition to the discharge destination.

Staff Interviews

On 05/02/19 at 1:00 pm, Staff G stated it is the hospital ED's standard practice to communicate with long-term-care facilities who send patients to the hospital ED for treatment. He/she stated the ED RN makes contact with the sending facility to give an update on the patient's treatment and condition at the time of discharge. Staff G confirmed that the sending facility for Patient #1 and #2, was not contacted by the ED RN.

In an interview conducted at the hospital conference room, 05/02/19 at 10:25 am, Staff J stated that, the ED nurse is to call the nurse at the nursing home for a nurse-to-nurse report. He/she stated the ED nurse should also inform the nursing home nurse the form of transportation utilized to return the patient to the nursing home.