HospitalInspections.org

Based on document review and interview, it was determined that for 1 of 5 clinical records (Pt #1) reviewed for discharge planning, the Hospital failed to ensure Pt #1's state guardian gave approval for Pt #1's discharge to a group home prior to Pt #1's discharge.

Findings include:

1. On 12/15/2020, the Hospital's policy titled, "Services Provided by the Social Services/Case Management Department" (effective 10/2018) was reviewed and indicated, "Purpose - to promote continuity of care and provide a plan for patient's concurrent and post hospital care needs, while utilizing hospital and community resources ...Social services and case managers confer with the patient/family, physician, nursing and other hospital staff to assess post-hospital needs..."

2. On 12/15/2020, the Office of State Guardian letter (dated 7/27/2020) regarding Pt #1 was reviewed and indicated the following;
"Prior approval should be obtained from the regional office staff which follows the ward during regular business hours (8:30 AM -5:00 PM). In typical situations, the after hours emergency numbers should not be contacted for the following - transfers involving changes in level of care or transfers from one Facility to another ..."

3. On 12/15/2020, Pt #1's clinical record, dated 6/18/2020 to 8/12/2020, was reviewed and indicated the following:

-Hospital course: Pt #1 is a 35-year-old ...swallowed 2 batteries approximately 4-5 days ago was admitted to ICU on 6/18/2020 with complaints of some increasing abdominal pain this morning upon admission. Pt #1 continued to have labile mood with periods of manic agitation, paranoia, auditory/visual hallucination putting herself and others at risk and she was evaluated multiple times by FCC (Family Counseling Center - contracted service for the Hospital) for inpatient psychiatry placement, however they failed to find an appropriate place for further inpatient psychiatry care. Pt #1 had problems with her aunt (who was her previous guardian) abusing her financially, adult protective services were involved, and she now has a state appointed guardian. Pt #1 was given options regarding various homeless shelters in Rockford and Chicago, she chose to go to a Women's Supportive Housing in Chicago where she was discharged today (8/12/2020) in stable condition.

-Pt #1's social service note, dated 8/12/2020 at 5:27 PM, indicated, "Notified State Guardian (Complainant 1) at the Guardian's Office and the Adult Protective Services regarding Pt #1's discharge and provided shelter information."
Pt #1's clinical record lacked documentation indicating that Pt #1's State Guardian gave approval for Pt #1's discharge to the group home prior to Pt #1's discharge.

4. On 12/15/2020 at 11:45 AM, an interview was conducted with the Social Worker (E #4). E #4 stated that she notified Pt #1's state guardian via phone message on 8/12/2020 after Pt #1's discharge that Pt #1 had been discharged to the group home in Chicago on 8/12/2020. E #4 stated that she did not obtain approval from Pt #1's state guardian prior to Pt #1's transfer to the group home. E #4 stated that she did not know that she needed to obtain the state guardian's approval prior to discharge.