HospitalInspections.org

Based on record review and interview, the facility failed to follow their policy to ensure that appropriate communication, documentation and notification of transfer was completed and failed to ensure their contracted staff and providers were qualified on EMTALA (Emergency Medical Treatment and Labor Act) regulations to perform appropriate transfers.

Findings include:

The facility failed to ensure appropriate transfer procedures were completed on transfer to an Acute Care Psychiatric Hospital. (See Tag 2409).

Systemic failures have the potential to affect all patients presenting for emergency services and transferred out to an Acute Care Psychiatric Hospital.

Based on record review and interview, the facility failed to follow their policy to ensure that appropriate communication, documentation, and notification of transfer was completed for 1 of 10 patients (Patient #11) who was transferred to another facility in a total sample of 20 Emergency Department (ED) medical records reviewed and failed to ensure staff and providers were qualified on EMTALA (Emergency Medical Treatment and Labor Act) regulations to perform appropriate transfers in 2 of 2 contracted staff (Registered Nurse (RN) S and RN X) and 1 of 4 providers (Resident V) on orientation in a total of 10 employee and provider records reviewed.

Findings Include:

A review of the facility policy titled, "Emergency Medical Treatment and Labor Act ("EMTALA")" effective 8/04/2021 revealed this facility "shall send a certification signed by a physician that... the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual... from being transferred. The certification shall contain a summary of the risks and benefits upon which it is based... shall ensure that the receiving facility has available space and qualified personnel for the treatment of the individual and has agreed to accept transfer of the individual."

Patient #11's medical record revealed patient #11 was an 8 year-old presenting to the Emergency Department 10/24/2022 at 6:40 PM with aggressive behavior and discharged 10/24/22 at 9:34 PM. "After Visit Summary" dated 10/24/2022 at 9:26 PM, signed by Patient #11's guardian under Instructions revealed "Go to [Acute Care Psychiatric Hospital Y] today."

On 12/13/2022 at 8:26 AM during interview with Emergency Department Fellow (MD) U, MD U stated the guardian was comfortable with outpatient management resources and that social services had offered information on available services "for future use." MD U stated it was not her/his plan to send Patient #11 to the [Acute Care Psychiatric Hospital]. The plan that was discussed with the social worker was to work with outpatient mental health resources.

On 12/13/2022 at 8:42 AM during telephone interview with Attending Physician T, Attending Physician T stated s/he was never under the impression there was a need or a plan for inpatient admission, believed the guardian was comfortable to take Patient #11 home, and instructed to take him/her to [Acute Care Psychiatric Hospital Y] "if his condition elevated." Attending Physician T confirmed "no, I didn't talk with another physician" complete transfer papers, or speak to another provider prior to Patient #11's discharge.

On 12/13/2022 at 1:25 PM during interview with Resident V, Resident V stated, s/he agreed with the social workers recommendation that Patient #11 was to be taken to [Acute Care Psychiatric Hospital Y] after discharge and ordered a second dose of Haldol (used to treat behavioral problems), at the guardian's request, "to safely transfer" Patient #11."

On 12/13/2022 at 1:51 PM during interview with Social Worker R, Social Worker R stated s/he was instructed, by the crisis center, to obtain help for Patient #11, Patient #11 would need to present to the emergency department of [Acute Care Hospital Y] after discharge. Social Worker R stated, on discharge, the guardian was given the option to take Patient #11 to the emergency department. Social Worker R stated [Acute Care Hospital Y] was not notified Patient #11 may present to the emergency department at [Acute Care Hospital Y]. Social Worker R stated there was a "good potential" the guardian would take Patient #11 to the emergency room and stated s/he knew the guardian "probably would."

Qualified Personnel

Record review of policy "Safety (Environment of Care) Education, effective date 9/20/2022 revealed all employees orientation will include content on " Emergency Management" and Department-Specific Orientation on "other regulatory agencies that applies to the department...within the first 90 days of employment."

Record review revealed Registered Nurse (RN) S was a contracted traveler staff with Emergency Department (ED) assignment start date 1/03/2022. There was no documentation that RN S received training on EMTALA regulations for appropriate transfers.

Record review revealed Registered Nurse (RN) X was a contracted traveler staff with ED assignment start date 5/08/2022. There was no documentation that RN X received training on EMTALA regulations for appropriate transfers.

On 12/13/2022 at 11:40 AM during interview with ED Manager N, Manager N stated travelers do not have requirements for annual education. Manager N confirmed they do not receive EMTALA training during orientation.

Record review revealed Resident Physician V started 7/01/2022, her/his EMTALA education was completed 11/11/2022 (greater than 90 days after her/his employment start date).

On 12/13/2022 at 2:50 PM during interview with Director of Safety M, Director M confirmed Resident V had not completed EMTALA training prior to 11/11/2022.