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895 NORTH 6TH EAST

MOUNTAIN HOME, ID 83647

COMPLIANCE WITH 489.24

Tag No.: C2400

Based on staff interview and review of medical records, it was determined the CAH failed to comply with the provisions at CFR 489.24(e,2,A and B). The CAH failed to ensure an appropriate transfer of a patient (#23), who had an emergency medical condition, had been performed. Specifically, the CAH failed to contact the receiving facility to ascertain space and qualified personnel were available to treat Patient #23. The CAH also failed to ensure the receiving hospital accepted Patient #23 for treatment. The findings include:

1. Refer to A2409 as it relates to the lack of communication between the CAH and the receiving hospital.

APPROPRIATE TRANSFER

Tag No.: C2409

Based on staff interview and review of medical records, it was determined the CAH failed to ensure an appropriate transfer for 1 of 23 patients (#23), whose records were reviewed for transfers, had been performed. The CAH failed to notify the receiving facility to determine space and qualified personnel were available to treat Patient #23 and to ensure the receiving hospital could accept the transfer. This had the potential to cause delays in the treatment of the patient following transfer. The findings include:


Patient #23's medical record documented an 8 month old male who presented to the ER on 1/20/11 at 10:22 PM. He was treated and transferred via helicopter at 10:50 PM. The physician dictation, dated 1/21/11 at 12:29 AM, stated Patient #23 had been born prematurely in April 2010 and had been hospitalized off and on since birth. The dictation stated an ambulance had responded to his home where he had suffered respiratory arrest and then cardiac arrest. The dictation stated paramedics had initiated CPR and Patient #23's pulse was restored. The dictation stated the ambulance had intended to transfer Patient #23 directly to a helicopter on the CAH's property. The dictation stated before the helicopter arrived, Patient #23 arrested again and the paramedics brought him into the ER to stabilize him. The dictation stated the infant's pulse was restored again and he was transferred to an acute care hospital with a pediatric intensive care unit.

Documentation was not present that the CAH had contacted the receiving hospital to ensure they had space and qualified personnel available to treat Patient #23. Documentation was also not present that the receiving hospital agreed to accept transfer. An addendum to the physician dictation, dated 1/27/11, 6 days later, stated "I did not make a doctor-doctor call prior to transfer, however, initially the [ambulance service] paramedic who was on scene had talked to the [helicopter control] Center and asked for the [air ambulance] team to be dispatched to his location. Then had changed that to meet at the Elmore helicopter pad. Initially, they had made report to the access center for direct transfer via [helicopter] to [the receiving] Hospital with the infant who was in respiratory arrest and then in cardiac arrest. Even at arrival to Elmore Medical Center the patient was not brought into the hospital as they were still trying to do a direct transfer to [the helicopter] and transfer the baby directly from the ambulance to [the helicopter to the receiving hospital]. However, during the transfer process the baby bradyed down [pulse rate decreased] and went back into cardiac arrest and had to be brought into the building. At that point the hospital unit clerk was in contact with the access center letting them know that the transfer had been delayed and the access center asked that they fax a face sheet and what we had on the code and ER to them at the access center and they would fax it on to [the receiving hospital]. This was done by the hospital unit clerk. Once the patient had a heart rate, pulse, and seemed stable [the helicopter] asked if they could take the baby on to [the receiving hospital] and was given permission. Once again the unit clerk in contact with the access center had faxed what we had and they had said they were going to forward that on to [the receiving hospital] and the helicopter crew did call and report to [the receiving hospital] prior to arrival."

The "INITIAL ASSESSMENT AND PLAN" from the receiving hospital was dated 1/20/11 at 11:28 PM and written by the physician who treated Patient #23 in that ER. The physician wrote Patient #23 was "Transferred here with only call received by paramedics, not transferring hospital." The note also stated the infant had a probable anoxic brain injury which likely occurred from lack of oxygen before paramedics arrived at his home.

The physician who treated Patient #23 at the CAH was interviewed on 2/23/11 at 12:05 PM. He stated the ER physician normally contacted the receiving hospital to inform them of an impending transfer. He stated Patient #23's case and transfer were unusual and he did not think about the infant as being a CAH patient. He said he just forgot to contact the receiving hospital.

The CAH failed to ensure the receiving hospital was notified of Patient #23's transfer.