HospitalInspections.org

Based on tour conducted of the Emergency Department, it was determined that signs specifying the rights of individuals with emergency medical conditions and women in labor, and whether the hospital participates in the Medicaid program were not posted conspicuously as required.

Findings include:

A tour of the Emergency Department conducted on 9/23/15, approximately 10:11 AM,
noted hospital signage was not conspicuously displayed in the treatment and waiting areas of the Emergency Department.
This was acknowledged by Staff #1 (Assistant Director of Nursing-ED), who was present during the tour.

Based on review document and interview, it was determined that the disposition of each individual seeking assistance in the ED was not consistently documented.

Findings include:

Review of the Emergency Department (ED) Central Log on 9/23/15, for the period
April 1, 2015 - September 2015, noted chief complaints and dispositions for the months of June, July, August and September were not completed.
It was determined that the facility failed to consistently meet all the requirements for maintenance of the ED central log.

This finding was acknowledged by Staff # 1 (Assistant Director of Nursing-ED).

Based on review of document and staff interview, in one (1) of eight (8) medical records reviewed, it was determined that the facility did not effectively meet the requirements for providing an appropriate transfer of patients presenting to the Emergency Department (ED). Specifically, there was no physician documentation of (a) the reason for transfer and notification of the risks and benefits of the transfer, (b) confirmation that the receiving facility accepted the patient for admission.


Findings include:

Review of patient MR#A, on 9/25/2015, revealed: This 60 year old patient, on 9/7/15 0402 (4:02 AM) arrived to the ED via EMS with a Chief Complaint of EDP (Emotionally Disturbed Person). The Medical History significant for Herniated Disc, previous psychiatric admissions and on Zyprexa 5mg daily. The patient was triaged and assigned Triage Category ESI (Emergency Severity Index) 3-Urgent. Vital Signs noted to be: Temperature: 99, Blood Pressure: 130/81, Respirations: 18, Pulse: 88. The patient was seen and examined by the physician who determined that the patient was "poorly groomed, irritable, with severely disorganized thought process and poor insight into her behavior. She is paranoid about the boyfriend and his friends."
Physician's documentation at 1147 (11:47 AM) noted that the patient "indicated that she is on a first pass (home visit) since she was admitted to Rockland State facility many months ago. She was transferred to a transition program there in August as per Rockland staff member. Was doing well on Zyprexa 5mg daily. Claimed to be compliant with it on pass. Presently denies any suicidal or violent ideation but is disorganized with poor judgment and needs a transfer back to her hospital for further stabilization. "

It was noted that the "Inter-Hospital Transfer Record" for patient MR#A, dated 9/7/15, failed to adequately document the reason for transfer, noting "patient is a patient in Rockland Psych." There was no documentation to indicate that the patient/patient's representative was informed of the risks and benefits of the transfer, or why not.
In addition, there was no physician's documentation to indicate that a physician at the receiving facility had been contacted and accepted the patient for admission and there was no documentation to indicate that a copy of the patient's ED chart was sent with the patient.


Physician's documentation on 9/7/15 at 12:15 PM, indicated that the patient was paranoid, grandiose, irritable with severe thought disorder, no thought into her behavior, poor judgement, needs inpatient care and transfer back to the facility. However, the patient was transferred back to a transitional residence (outpatient) and not to a "hospital for further stabilization."
This was brought to the attention of Staff #3 (MD, Chairman of Psychiatry) and Staff #4 (Social Worker) Mental Health. Upon interview on 9/25/15 at 1:50 PM, Staff #4 stated that she contacted the facility and spoke with someone in the admitting office and did not know that it was a transitional residence.

The facility failed to provide an appropriate transfer to another medical facility.