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Based on interview and document review, staff members are not consistently following the facility's policies and procedures for discharge planning. This was noted in four of four medical records reviewed.

Based on interview and document review, staff members are not consistently following the facility's policies and procedures for discharge planning. This was noted in four of four medical records reviewed.

Findings:

The facility's policy titled "Case Management Clinical Review" states that all patients are reviewed by case management staff with 24 hours or one business day of admission for an admission review and on a daily basis for a continued staff review.

Medical Record #1

The patient's medical record was reviewed on 2/23/12. There is no documentation that this patient was reviewed by Case Management staff. It was confirmed on interview with the director of Case Management staff on 2/24/12, that a notation should be made in the record regarding the initial assessment even if the patient did not require further intervention by Case Management staff.


Medical Record #2

The patient's medical record was reviewed on 2/23/12. Documentation in the patient's medical record indicated that the patient's discharge plan was nursing home placement. The patient was admitted on 2/10/12, a note on 2/17/12 indicated that the patient was to go to a nursing home. Even though nursing home placement was planned for this patient, there was no evidence of involvement by Case Management Staff. There were no Case Management notes until 2/23/12 which indicated that the patient had gone to the operating room.

Medical Record #3

The patient's medical record was reviewed on 2/23/12. The patient was admitted on 1/21/12. The patient required an ICU admission on 1/23 for mechanical ventilation. Documentation in the patient's medical record on 2/8/12, indicated that the patient's discharge plan was sub-acute rehabilitation. There were no notes by Case Management staff until 2/13/12.

Medical record #4

The patient's medical record was reviewed. This patient was admitted on 2/19/12. The patient's medical record was reviewed on 2/23/12. There is no documentation that an initial assessment had been conducted by case management staff

Based on staff interview, patients are not provided "An Important Message From Medicare About Your Rights" as required by Medicare.

Findings

Upon interview with Case Management Staff and nursing on 2/24/2012, the staff stated that they do not give patients covered by Medicare "An Important Message From Medicare About Your Rights" unless the patient disagrees with the discharge. The staff stated that if a patient disagrees with the discharge, then the Medicare discharge notice is given to the patient at that time, so that the appeal process of the discharge can be initiated.

Based on interview, the facility has not fully intergrated the discharge planning process into the hospital's QAPI program.

Findings:

Discussions with Quality Assurance and Utilization Review staff as well as case management, social work and administration, confirmed that discharge planning reviews were in place but the results of these reviews had not been reported through the hospital wide quality review program. Survey staff were provided information regarding several discharge planning initiatives but the results from these studies had not been thoroughly analyzed. These findings were confirmed on 2/24/2012 at the exit conference.