HospitalInspections.org

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Based on interview, record review, and review of the hospital policies and procedures, the hospital failed to adopt and implement a policy and procedure in the Emergency Department for obtaining a completed and signed, or documentation of the attempt to obtain a signed record of a patient leaving the hospital against medical advice.

Failure to comply with EMTALA regulations risks poor patient outcomes, injury and death.

Findings included:

The hospital failed to obtain a signed AMA form when a patient insisted on leaving the hospital rather than wait for a transfer to an accepting facility.

The hospital policy and procedure for patients leaving against medical advice specifically excluded the Emergency Department.

Cross Reference: A 2407

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Based on interview, document review and review of hospital policies and procedures, the hospital failed to obtain, or attempt to obtain, a written refusal of care for a patient leaving against medical advice (AMA) who did not want to wait for an appropriate transfer to another faclility for 1 of 8 transfer records reviewed .

Failure to obtain a written refusal risks patients' lack of understanding of the risks and benefits of remaining at the facility until an appropriate transfer for care could be facilitated resulting in possible patient injury or death.

Findings included:

1. The hospital policy titled, "Patients Leaving or Discharging Against Medical Advice," no number, reviewed 11/09/21, showed that the scope of the policy workforce excluded the Emergency Department.

2. On 05/03/23 at 12:30 PM, during an interview with the investigator, a staff nurse working in the Emergency Department (Staff #1) stated that if a paitent refused a transfer and wanted to leave, they would explain risks and benefits of the transfer or refusal of transfer. They stated that it would be very rare that a patient did not sign an AMA form.

3. Medical record review for the complaint subject patient showed that there was no AMA form in the medical record (Patient #22).

4. On 05/03/23 at 11:25 AM, during medical record review, the Emergency Department Manager, (Staff #2) verified that there was no AMA form in the medical record documentation for Patient #22.