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A. Based on review of the Transfer Reports log, staff interview and clinical record review, it was determined that for 1 of 11 (Pt. #1) patient requests for transfer acceptance in January 2011, the Hospital failed to accept the transfer of a patient requiring specialized care, (A 2411).

A. Based on review of the Transfer Reports log, staff interview and clinical record review, it was determined that for 1 of 11 (Pt. #1) patient requests for transfer acceptance in January 2011, the Hospital failed to accept the transfer of a patient requiring specialized care.

Findings include:

1. The Transfer Reports log from 2010 and 2011 was reviewed on 4/4/11 at 11:00 AM. Pt. #1 was not included in this log. The log contained a list of phone calls received from other hospitals requesting a transfer to the trauma center (Advocate Illinois Masonic Medical Center - AIMMC) for further care.

2. The Director of Emergency, EMS and Trauma was interviewed on 4/4/11 at 1:35 PM. She presented the triage criteria for patient requirements to a Level 1 Trauma Center. She stated that "for a transfer from another hospital, a call is received from the requesting hospital and the trauma surgeon on call is notified. The surgeon makes a decision to accept the patient or not based on the triage criteria. If the surgeon chooses not to accept, they must call the requesting physician directly to discuss why not ". All phone calls requesting a transfer to the hospital are documented on the " transfer report ". The Director indicated that if a physician takes the transfer request phone call, a form is not processed because the physician makes the decision at the time of the call. The Director reviews all forms filled out for completion and places that information on an Excel spread sheet.

3. The Oral Surgeon (MD#2) that specializes in mandible fractures for AIMMC was interviewed via telephone on 4/4/11 at 3:30 PM. He stated that he did recall a phone call about a minimally displaced fracture of a mandible, but did not recall the patient 's name. MD#2 was contacted by the AIMMC trauma Surgeon about Pt. #1 and decided to place a call to the Hospital requesting a transfer, (Hospital A) himself. MD#2 stated that he had a direct conversation with the Emergency Room physician at Hospital A and after discussing the situation, felt that the patient did not require transfer. MD#2 decided that this fracture could be treated as an outpatient in his office on the next business day of 1/31/11 and did not require inpatient treatment. MD#2 stated, "Pt. #1 did not have any further head trauma, so I requested that the Emergency Room physician provide Pt. #1 with a prescription for an antibiotic and pain medication. The follow up appointment was made for first thing Monday AM ". Pt. #1 was not transferred to AIMMC.

4. The clinical record of Pt. #1 from Hospital A was reviewed on 4/5/11 at 8:45 AM. Pt. #1 was a 21 year old male who presented to Hospital A's Emergency Department on 1/29/11 at 11:33 AM with complaints of left sided facial pain after sustaining an injury while using exercise equipment.

The Emergency Department physician (MD#3) ordered a CAT scan of the head and facial bones which showed a "minimally displaced fracture of the mandible on the left with associated soft tissue swelling both medially and laterally from the mandible. ... There is considerable shift of the midline structures to the right".

MD#3 called AIMMC at 1/29/11 at 1:10 PM to discuss the case for transfer. AIMMC would call back with the trauma team's recommendations. An untimed MD note included, "AIMMC initially called back stating patient does not qualify as a trauma transfer, but they would have the oral surgeon call back to let us know when they want to see the patient. Oral Surgeon (MD#2) returned phone call and will have patient follow up on Monday morning at his office" .

Patient #1 was discharged home on 1/29/11 at 2:45 PM with the diagnosis of Left minimally displaced mandible fracture - ramus in stable condition with a prescription for pain medication. Pt. #1 was to follow up with MD#2 first thing Monday morning.

According to another clinical record for Pt. #1 from the receiving Hospital (Hospital B), Pt. #1 subsequently presented to the Emergency Department at Hospital B on 1/30/11 at 11:12 AM with complaints of "unable to open mouth and difficulty taking a deep breath". Pt. #1 required nasal tracheal intubation and admission to Intensive Care for a narrowed airway due to swelling from the fracture. After stabilization, Pt. #1 underwent an open reduction internal fixation of his mandible fracture on 2/4/11 and was discharged home on 2/6/11.

5. A request was made by Hospital A on 1/29/11 to transfer Pt. #1 to AIMMC for mandible fracture care. Hospital A did not have the necessary services available for Pt. #1's care. AIMMC did not accept Pt. #1 for transfer and further assessment.