HospitalInspections.org

Based on interview and the document review, the Critical Access Hospital (CAH) failed to assure all patient services including contracted services, physicians and hospitals that accept the CAH's transferred patients, and patient admissions are included in the CAH's Quality Assurance Performance Improvement (QAPI) program.

Findings included:

- Review of the CAH's QAPI plan, last approved by the Governing Body on 9/8/09, defined the scope of the QAPI program to include "inpatient and outpatient care, direct and indirect care provided by the health system". . revealed all patient services will be evaluated through the QAPI program.. The CAH failed to assure patient care services provided by agreement are included in the QAPI program..

- Review of the QAPI calendars and meeting minutes revealed information presented by departments of the hospital. The CAH failed to include contracted services including supporting hospitals and on-call physicians in the QAPI program.

- Staff H, interviewed on 8/5/10 at 11:00am, confirmed the CAH failed to include contracted services including on-call physicians and hospitals that receive transferred patients. Staff H verified the CAH failed to consider the admission of a patient who required cardiac intensive care to the CAH as a QAPI issue.

- Patient #1 presented to the Emergency Department (ED) on 6/18/10 at 1:55am with complaints of chest pain. Staff D (mid-level practitioner- PA/ARNP) examined patient #'1's in the ED. Staff D determined patient #1 required intensive cardiac care. Staff D placed two telephone calls to the on-call cardiologist at Hospital F and requested to transfer. The on-call cardiologist at Hospital F refused to accept the transfer of patient #1.

Staff D called Physician C (family practice) on 6/18/10 at 2:50am to report the assessment findings of patient #1 and the refusal of Hospital F to accept the patient. Physician C, who did not examine patient #1, ordered patient #1 to be admitted to the CAH based on Staff D's assessment

Staff D interviewed on 7/19/10 at 10:30am stated the patient required transfer to a hospital with a cardiac catheterization laboratory. Staff D stated they "should have called another cardiologist" when the transfer was refused. Staff D acknowledged Patient #1 required a higher level of care than the CAH provided.

The CAH admitted Patient #1 with knowledge the CAH could not provide the care the patient required.

- Staff H interviewed on 8/5/10 at 11:00am verified the CAH failed to include all contracted patient care services including the on-call cardiologist and Hospital F's refusal to accept a patient for transfer in the QAPI program. Staff H confirmed the CAH failed to include the admission of a patient who required specialized care not provided by the CAH in the QAPI program.