HospitalInspections.org

Based on record review and interview the facility failed to complete a discharge evaluation on a timely basis so that appropriate arrangements for post-hospital care were made in 1 of 10 sampled patients (SP #11).

The findings:

Record review showed that sampled patient (SP) #11 presented to the ED on 2/21/2018 around 11:56 PM via rescue with the chief complaint taken as Shortness of Breath (SOB) since that morning. On 02/22/2018 the ED physician notes showed patient cannot recall his medications. (Two) 2 rounds of duonebs given. But patient still has persistent wheezes and dyspnea. Will admit for COPD and chest pain.

Medical student notes dated 2/22/2018 at 11:48 AM showed SP#11 to have multiple recent hospitalizations for similar exacerbations, but non-compliant with medications (not taking while at home). Patient would benefit for further cardiac workup but given the medication noncompliance, history of patient always leaving AMA, and lack of consistent follow up, the risk of surgical intervention outweighs the benefits. Working with Social Worker to schedule home safety evaluation, consulting with DCF (Department of Children and Families) for possibility of elder neglect.

ED progress notes by the ED (Emergency Department) Attending Physician dated 2/22/18 at 14:08 PM showed, due to social problems, patient is held until contact with a family member is done. He (Patient) had social issues with a DCF investigation. Social worker observed that patient had some confusion and requested a psych evaluation for capacity. However, the patient had not exhibited any behavior that would make him an imminent harm to himself or others. Pending evaluation patient left AMA.

Interview on 4/18/2018 around 11:50 AM with the SW(Social Worker) for ED Quality and Patient Safety, and the SW Case Manager #1 (on the Phone), and SW- Case Manager #2 showed that they facilitated the DCF consult for SP#11 by the ED Team for a possible elderly abuse due to patient claiming that he was lock out of the house and have no place to go. Patient was not a Baker Act case so the DCF wanted to have a psych evaluation to determine competency to make decision including discharging self. DCF wanted to hold the patient until they find a placement for him.

Review of the CM/SW (case management/ social worker) notes dated 02/24/2018 showed electronic chart reviewed: per previous social worker notes, DCF was called for neglect and case has been accepted. On 02/23/2018 [named] came and met with the patient. A psyche consult was placed but it seems that the patient left the hospital AMA.

Interview via phone on 4/19/2018 around 2:30 PM with the ED attending who managed SP#11 revealed that based on his examination, patient was competent to make his own decision, and wanted to be discharged. The ED attending also stated that he ordered the psych evaluation for competency as requested by the social worker, and even told the patient to wait until the psych team comes to evaluate him but patient did not want to wait and left AMA.