HospitalInspections.org

Based on document review and staff interviews, the hospital's administrative staff failed to ensure that the hospital staff contacted the patient's guardian and provided them with the opportunity to make decisions regarding the patient's care for 1 of 1 reviewed emergency department patient with a guardian (Patient #1). Failure to provide communication to the patient's guardian resulted in the guardian lacking the opportunity to make decisions regarding Patient #1's care, potentially resulting in the hospital staff failing to address concerns with the patient's care, participate in the patient's discharge planning, and changes to the patient's level of care. The hospital's administrative staff identified an average daily census of 441 inpatients and 190 Emergency Department patients for the current fiscal year.


Findings include:

1. Review of Patient #1's medical record revealed that Patient #1 presented to the hospital's emergency department on 10/29/21. The hospital staff evaluated Patient #1, provided medical treatment, and discharged Patient #1 from the hospital. Patient #1 left the emergency department, was found by someone in the parking lot, and was returned to the hospital's emergency department. Patient #1 claimed they fell in the parking lot after the hospital staff discharged Patient #1. Patient #1's medical record lacked evidence that the hospital staff contacted Patient #1's guardian regarding Patient #1's medical care.

2. During an interview on 12/1/21 at 11:31 AM, Social Worker (SW) A revealed that social workers are assigned to patients if the medical staff caring for the patient identifies a need for the social worker to provide social work services to patients at any point of the patient's continuum of care. SW A further revealed the only way a social worker would interact with the patient, or patient's guardian, would be if a social worker was assigned to that patient. SW A indicated there are 2 social workers assigned to the Emergency Department from 8:30 AM until 10 PM Monday through Friday, and on call during the weekend. Each inpatient floor has a social worker on the floor, who works with the Case Manager, and their responsibilities include contacting a patient's guardian if needed.

3. During an interview on 12/1/21 at 11:48 AM, with Case Manager (CM) C revealed that the case manager's job includes reviewing all inpatient charts to identify if a patient has any special needs. The case manager will review the patient's history and physical, emergency contact and demographic information for the patient. CM C further revealed that each inpatient hospital floor has a case manager, but the Emergency Department and other outpatient areas do not have a case manager assigned to the area.

4. Review of the policy, "Patient Rights and Responsibilities Policy," effective 5/2017, revealed in part, " ... patient who is incapacitated, when an individual present the hospital with an advance directive, medical power of attorney or similar document executed by the patient and designating an individual to make medical decisions for the patient when incapacitated, then the hospital must ... provide notice of policies." The policy lacked guidance to the hospital staff regarding providing communication with the appropriate individual for patients with a medical power of attorney or guardianship.

5. Review of the policy, "Consents," effective 1/2018, revealed in part, " ... a surrogate decision-maker with the capacity to understand may give consent, after being informed of the proposed health care treatment, the likelihood of achieving goals, and alternatives to the health care treatment, including the alternative of no health care treatment." The document included information that a patient's guardian may provide consent for a patient's care.

6. During an interview on 12/1/21 at 12:08 PM, Patient #1's Brother revealed that Patient #1's Brother had guardianship for Patient #1 since 2019. Patient #1's guardianship paperwork was provided to the hospital staff prior to Patient #1 presenting to the hospital on 10/29/21. On 10/29/21, Patient #1 presented to the hospital via ambulance and Patient #1's Brother was waiting in the hospital's lobby while Patient #1 received care in the Emergency Department. When Patient #1's Brother had to leave the hospital, Patient #1's Brother informed the hospital staff to contact Patient #1's Brother if the hospital staff needed to update Patient #1's Brother regarding any changes in Patient #1's status or if the hospital staff needed Patient #1's Brother to make any medical decisions for Patient #1.

The hospital staff later discharged Patient #1 from the hospital without ensuring Patient #1 had someone to accompany Patient #1 safely home (despite knowing Patient #1 had a guardian). Patient #1 fell in the hospital's parking lot, had to borrow a phone from a passerby, and called Patient #1's brother. Patient #1's Brother ensured that Patient #1 returned to the emergency department. The hospital staff failed to notify Patient #1's Brother that the hospital staff had discharged Patient #1 from the emergency department.

6. During an interview on 12/1/21 @ 12:30 PM, the Director of Accreditation/Regulatory acknowledged they could not locate a policy instructing the hospital staff on the expectations regarding communications for patients with legal guardians, especially communication regarding the patient's discharge planning, changes in the patient's level of care, and/or medical decisions for the patient.