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Based on interview and record review, the hospital (Hospital A) failed to ensure the Emergency Department (ED) followed regulations for transfer of one out of 46 sampled patients (9) when Patient 9 was transferred to another hospital (Hospital B) without Hospital B's acceptance, which had the potential to result in Hospital B not having the capacity or capability to treat Patient 9's medical condition.

Findings:

The clinical record for Patient 9 from Hospital A was reviewed. The ED physician notes dated 1/24/14, indicated Patient 9 presented to the ED with infections to his face and left leg. Patient 9 had stated to ED Medical Doctor (MD) 8 that the symptoms of wound drainage and pain was constant and worsening. MD 8 determined Patient 9 required the specialized services of an orthopedic physician but none were available at Hospital A so he wanted to transfer him to Hospital B. MD 8 charted: "I discussed care with the house supervisor/bed supervisor at (Hospital B) to try to coordinated appropriate higher level of care...disposition has not been made at this point."

During a concurrent interview with the ED Director (EDD) and review of the clinical record for Patient 9 on 2/24/14, at 3:45 PM, he verified the clinical record did not indicate if Hospital B had accepted Patient 9, to include date, time, and person accepting the patient. The EDD verified a nursing note written by Clerk C on 1/24/14, at 6:23 AM, read "Spoke to (Transfer coordinator's name) at (Hospital B) and was notified there isnt (isn't) any beds available at this moment." The EDD verified the transfer summary form for Patient 9 had the person accepting for the hospital as MD 9, not the transfer coordinator.

The clinical record from Hospital B for Patient 9 was reviewed. The History and Physical, dated 1/24/14, indicated Patient 9 had, at the time of transfer, infected wounds to his upper thigh, left cheek, right elbow, and right forearm. These wounds were sustained from multiple gunshot wounds approximately one month prior. The discharge summary dated 1/27/14, indicated Patient 9 had diagnoses of left thigh wound infection, facial infection, a new-onset diabetes, and during surgery, a bullet was removed from his left buttock.

During an interview with Quality Manager 1 at Hospital B on 2/26/14, at 2 PM, she stated after reviewing the transfer logs and records, there was no indication found that Hospital A contacted Hospital B for the transfer of Patient 9.

The policy and procedure for Hospital A titled "Patient Transfer" dated 1/23/13, read under 6.b "The Hospital will confirm with the receiving facility that it has the capability and capacity (such as available beds and qualified personnel) to treat the individual, and has agreed to accept the transfer. The Hospital should contact the receiving facility before contacting an accepting physician. If the receiving facility has established a transfer center or central number for processing requests for transfers, the Hospital should contact the transfer center or use the central number. The name of the person accepting the transfer on behalf of the receiving facility and the time of acceptance should be documented in the medical record. Transfer of an individual whose emergency medical condition is stabilized...A stabilized individual may be transferred upon the request of the individual, a pre-arranged transfer with a receiving facility...The Hospital will document the acceptance of the individual by the receiving facility in accordance with paragraph 6.b above."