HospitalInspections.org

Based on review of the facility Standard Operating Procedures, review of a Case Manager's Position Description, medical record review, observation, and interview, the facility failed to complete a timely discharge planning evaluation for one patient (#15) of 19 sampled patients.

The findings included:

Review of facility Standard Operating Procedures dated May 2012 and provided by the Nursing Clinical System Coordinator on November 20, 2012, revealed, "...Discharge/Transfer...Discharge Planning is a collaborative effort by nursing and other disciplines, such as Case Management and begins upon admission..."

Review of a Case Manager's Position Description dated August 5, 2012, revealed, "...Performs a comprehensive patient/family assessment with (within) 48 business hours of admission...Collaborates with other disciplines in developing and implementing a comprehensive, safe discharge plan..."


Medical record review revealed Patient #15 was admitted to the facility on November 15, 2012, with diagnoses including Left Hip Fracture.

Medical record review of a physician's order dated November 18, 2012, revealed, "...CM (Case Management) for DCP (discharge planning) to rehab (rehabilitation)."

Medical record review of a Case Management Assessment dated November 19, 2012, at 10:07 a.m., revealed, "Physical Status (Prior to Admission)...Independent...Transportation needs at Discharge Ambulance...S/W (spoke with) pt (patient) and pt's 3 Dtrs (daughters) in Rm (room) for > (greater) 30 mins (minutes) to explain DC (discharge) process...dtrs to visit/research SNFs (skilled nursing facilities) and notify CM of top 3 choices..."

Medical record review of a Case Management Discharge Planning Addendum dated November 19, 2012, at 2:45 p.m., revealed, "S/W pt's dtr (Daughter #1). Pref (preference) of SNF (1.) no beds available this wk (week)...(2.)...(3.)...faxed referral to (2.) and (3.) Awaiting acceptance."

Interview with Daughter #1 on November 20, 2012, revealed the patient was admitted on November 15, 2012, had surgery on November 16, 2012, and staff assisted with discharge plans. Daughter #1 stated, "...We never saw Case Management until Monday (November 19, 2012)...were told one Case Manager on Saturday for the whole hospital and on Sunday (facility had) an on-call person. (There) were attempts from nursing staff to get them to us sooner but it did not occur. We questioned how Case Management could begin on Monday and discharge on Monday. I told (Unit Nurse Manager) if I could just talk with someone it would help...(Unit Nurse Manager) looked yesterday if anything in Case Managment in file and there was nothing. They're doing well now..."

Interview with Case Manager #1 on November 20, 2012, at 9:55 a.m., in a fifth floor break room, revealed she was responsible for Patient #15's discharge planning. Continued interview revealed discharge planning begins on admission and Case Managers have forty-eight hours to complete an initial screen, and confirmed the facililty had failed to timely complete a discharge evaluation for Patient #15. She stated, "...one on-call Case Manager on weekends and they deal with patients who are discharged on weekend days. That's why this patient wasn't seen until Monday."