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Based on patient and staff interview, and clinical record review, the facility failed to honor the patient's right to make an informed decision and to be involved in care planning, when Patient 1's request to be transferred to a specific hospital was not taken into consideration. This failure resulted in Patient 1 feeling ignored and anxious when transferred to a hospital not of his choice and by a mode not of his choice.

Findings:

1. On 9/22/10 at 10:00 a.m., during an interview, Patient 1 stated he was in the ED with a complaint of chest pain. Patient 1 stated he was told he needed to be transferred to a hospital for a possible cardiac catheterization (a procedure to evaluate heart function) as soon as possible. Patient 1 stated at this time he requested he be transferred to Facility #2.

Patient 1 stated he was told it would be hard to get a bed for him there, and Facility #1 would be transferring him to Facility #3.

Patient 1 stated he requested several times to be transferred by ambulance to Facility #2 because he believed it was the better hospital for his problem. Patient 1 stated he felt pressured into signing papers and does not remember signing a transfer consent to Facility #3.

2. Patient 1's emergency room record, dated 9/8/10, indicated no documentation in the doctor's progress notes or the nurse's notes that Patient 1 had requested to be transferred to Facility #2.

The "Inter-facility Transfer Record" dated 9/8/10, indicated no notations of an attempt to meet Patient 1's request for transfer to Facility #2.

3. On 12/2/10 at 3:50 p.m., during an interview, the EDM stated if a patient requested to be transferred to a specific hospital, the request was taken very seriously and was relayed to the Supervisor who was designated as the person making the actual transfer arrangements. The EDM stated the transfer center was "very good" about trying to meet the patient's request. The EDM also stated if a request was made by the patient, a note should be documented in the chart or on the transfer request form.

4. On 12/8/10 at 10:30 a.m., during an interview, RN 2 stated there was no communication given to her regarding the patient's request for transfer to Facility #2. RN 2 stated she did not receive a request indicating Patient 1 wanted to go to Facility #2.

RN 2 stated the usual procedure was to write a note in the margin of the transfer request any special requests from the patient and the information was relayed to the transfer center. RN 2 stated there were no notations on Patient 1's transfer form. .

5. On 12/9/10 at 10:40 a.m., during an interview, RN 1 stated he was designated as Charge Nurse for the day of Patient 1's visit. RN 1 stated he does not recall this patient or the circumstances surrounding the transfer.

RN 1 stated the Supervisor - RN 2 - was the designated person in charge of the transfer arrangements for Patient 1. RN 1 stated any information regarding Patient 1's request for transfer to a specific hospital would have been gathered and documented by RN 2.

RN 1 stated the supervisor in charge of the transfer arrangements gathered all necessary information directly from the patient needing the transfer and documented on the transfer form.