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Based on record review and interview, the hospital's discharge process failed to identify at an early stage of evaluation the patients' needs for discharge from the emergency department. This deficient practice was evidenced by:
1. Failure of the emergency department to provide a detailed description of the patient's treatment course to the receiving facility when discharged from the emergency department in 3 (#1, #2, #5) of 4 (#1, #2, #5, #8) patients evaluated for discharge/transfer via Emergency Medical Services (EMS) to an outside facility from a sample of 8 patients evaluated for discharge planning from the emergency department.
2. Failure of the emergency department to ensure a discharged patient had safe transportation home in 1(#4) of 1 patient who arrived at the hospital via EMS with no family or social support from a sample of 8 patients evaluated for discharge planning from the emergency department.
Findings:

1. Failure of the emergency department to provide a detailed description of the patient's treatment course to the receiving facility when discharged from the emergency department.

Review of the hospital operational standard titled, "Admission, Discharge, and Transfer Guidelines for the Emergency Department," dated August 2018 revealed in part, "the transferring staff will provide a verbal handoff to the transporting personnel and receiving facility. Copies of the medical record, including the documentation and diagnostics, will be provided to the receiving facility by the transporting personnel."

Patient #1
Review of the emergency department record of Patient #1 dated 06/02/2021, navigated by S4Information Technology (IT), revealed Patient #1 was transported to the hospital by EMS with a chief complaint of "altered mental status" of 4 days' duration. Patient #1 was a 66-year-old nursing home resident with cerebral palsy. The patient was noted to have stable vital signs despite elevated white blood cell count of 17.4. After blood and urine were collected for culture, EMS transport was requested to return the patient to the nursing home. The nurse documented the nursing home could not be contacted to give a report of the visit. She documented the transport driver was to notify the home that the emergency department needed to speak with the home. There was no documentation the nursing home was notified of the emergency department course for Patient #1 and no documentation that copies of the medical record were sent with the transport. This was verified on 06/14/2021 at 11:38 a.m. by S1Emergency Department (ED) Director and S4IT.

Patient #2
Review of the emergency department record of Patient #2 dated 06/04 2021, navigated by S4IT, revealed Patient #2 was transported to the hospital by EMS with a complaint of "abscess on back." Patient #2 was a 90-year-old nursing home resident. Patient #2 was evaluated and noted to be stable. Physical exam revealed a lipoma. EMS transport was requested to return the patient to the nursing home. The nurse documented a failed attempt to contact the nursing home. There was no documentation the nursing home was notified of the emergency department course for Patient #2 and there was no documentation that copies of the medical record were sent with transport. This was verified on 06/14/2021 at 11:45 a.m. by S1ED Director and S4IT.

Patient #5
Review of the emergency department record of Patient #5 dated 02/26/2021, navigated by S4IT, revealed Patient #5 was transported to the hospital by EMS with a chief complaint of "wound check." Patient #5 was a 91-year-old nursing home resident on Coumadin who had a laceration on his foot sutured within the past 24 hours which had begun to bleed. Patient #5 was evaluated and noted to be stable. Quick clot was applied to the laceration and the patient was monitored for further bleeding. EMS transport was requested to return the patient to the nursing home. There was no documentation the nursing home was notified of the emergency department course for Patient #5 and there was no documentation that copies of the medical record were sent with transport. This was verified on 06/14/2021 at 12:23 p.m. by S1ED Director.

2. Failure of the emergency department to ensure that a patient that arrived by EMS and discharged had safe transportation home.

Patient #4
Review of the emergency department record of Patient #4 dated 02/25/2021, navigated by S1ED Director, revealed Patient #4 was transported to the hospital by EMS with a chief complaint of "shortness of breath". Patient #4 was a 77-year-old female and had a medical history of Congestive Heart Failure, Diabetes Mellitus, and Hypertension. Patient #4 arrived to the hospital alone and with no family members. The patient had a daughter and son listed as emergency contacts. The patient had testing procedures performed and determined stable for discharge. There was no documentation the patient's daughter or son were contacted regarding the patient's discharge. In an interview on 06/14/2021 at 1:49 p.m., S2Registered Nurse (RN) indicated she did not contact the patient's family prior to discharge. S2RN indicated she gave the patient discharge instructions and thought the patient would call for a ride home. S2RN indicated the patient's daughter called and asked if the patient was at the hospital. S2RN indicated the patient's daughter told her the patient had dementia. S2RN indicated that after the phone call from the patient's daughter the hospital confirmed the patient had a diagnosis of dementia. S2RN indicated the patient should not have been discharged home alone and without a responsible person.

In an interview on 06/15/2021 at 8:33 a.m., S1ED Director indicated if patients arrived by EMS with no responsible person present staff should ensure that the patient had a way of getting home safely prior to being discharged from the ED.

In an interview on 06/15/2021 at 8:35 a.m., S1ED Director verified improvements to the discharge process were necessary to ensure the safety of patients discharged from the emergency department. She verified that efforts should be made to confirm and document how the patient will get home and she verified that the emergency department personnel failed to document notification of the receiving facility when transferring patients by EMS.