HospitalInspections.org

Based on Hospital documents, and staff interviews, it was determined that in 1 of 1 (Pt. #1) ED record reviewed requesting a transfer and 3 of 10 (Pt. #s 24, 26 and 27) records reviewed of refusals to accept transferred patients, the Hospital failed to accept a request for transfer of patients in need of specialized psychiatric services. (A2411).

Based on review of Hospital documents and staff interview, it was determined that in 4 of 4 (Pt. #s 1, 24 , 26 and 27) patients' Hospital Intake Screening Tool and/or clinical records, the Hospital failed to accept patients in need of specialized psychiatric services.

Findings include:

1. Although there was no documentation of an encounter with Pt. #1 at Hospital A, the clinical record of Pt. #1 from Hospital B was reviewed and documented that on 9/6/12, E#4 from Hospital A stated, "this pt. attacked staff previously and the MDs will not accept transfer." E#4 was on duty on 9/6/12 at Hospital A and was responsible for receiving intake calls for patients requesting transfer to Hospital A. Pt. #1 was ultimately transferred to Hospital C.

2. Hospital A's Screening Tool for Pt. #24 was reviewed. This was a 52 year old male screened by Hospital A for acceptance. On 5/7/12, the note on the screening tool stated that MD E#3 from Hospital A, "refuses pt. from Hospital D, states they have their own psych unit."

3. Hospital A's Screening Tool for Pt. #26 was reviewed. This was a 26 year old female screened for acceptance by Hospital A. On 5/17/12, a note on the screening tool stated that MD (E#12) refused to admit Pt. #26 for "non-compliance."

Hospital A did not refuse to receive transfer patients based on its lack of capacity or capability to provide specialized services, but rather, they refused based on their policy and physicians' discretion.

4. Hospital A's Screening Tool for Pt. #27 was reviewed. This was a 60 year old female screened for acceptance by Hospital A. On 8/12/12, a note on the screening tool stated that MD E#12 "made aware of Pt's history and status at Hospital A but E#12 refuse to accept Pt. #27 stating, "several hospitals in-between them" (Hospital A's and Hospital G).

5. Hospital's A Screening Tool is tool used to screened patients who are being
transferred from other facilities for acceptance or admission into Hospital A. The screening tool includes biographical and clinical information about the patient, as well as documentation of whether the patient was accepted or refused for transfer, and the reason for refusal. The tool also includes the name of the physician who refused the patient.

6. Hospital's A Policy entitled, ""Ineligibility for Admission," revised 6/30/06 was reviewed and required, "To provide guidelines for those patients that are deemed inappropriate for admission.....7. Patients who have consistently demonstrated noncompliance with previous inpatient and/or follow-up arrangements....."

7. Several staff members interviewed, regarding refusal of patients admission into Hospital A, stated the following:

- E#4-"It is seldom that the psychiatrist refuses the patient unless they know they cannot handle the patient medically..."
- E#3-at times, patients are refused admission because there are no beds available, developmentally delayed, under 18 years, if referring hospital has similar care and has been at the hospital for several days etc.
- E#8-if a patient is known to the facility with violent behavior and is being referred from another hospital as an inpatient, sometimes they are refused.
- E#5, "we have to make sure pt. is appropriate for our unit. If a hospital has their own unit but may be trying to inappropriately dump patients on us. If patient has had major crisis in ED i.e. hit staff, violent, it's risky sometimes taking these patients and then I look a little more critically....so we don't get dumped on."

8. Throughout the survey investigation, the Vice President of Compliance (E#14) was made aware of and verified the findings.