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Based on interview and record, the hospital (Hospital 2) failed to accept transfer of one of 21 sampled patients, (Patient 21) from another hospital (Hospital 1). This failure had the potential to result in a delay of care and treatment.

Findings:

During an interview on 6/12/2023, at 9:50 a.m., with Registered Nurse (RN) 1, RN 1 stated, calls from other hospitals would go to the transfer center, the house supervisor are sometimes involved with any question with the transfer center. Acceptance or refusal would go through the transfer call center.

During an interview on 6/12/2023, at 10:15 a.m., with House Supervisor (HS) 1, HS 1 stated, transfer center calls her to see if the hospital has an available bed.

During an interview on 6/12/2023, at 2:50 p.m., with HS 2, HS 2 stated, typically if there is a transfer request for a transfer the call goes to the transfer center who evaluate the case. Calls comes from the transfer center, they ask routine questions like what beds are available. We do ask questions of the call center, like what services they are looking for.

During an interview on 6/13/2023, at 4:28 p.m., with Hospital 1's Transfer Center Staff (TCS) 1, TCS 1 stated, "I remember the case, we were trying to transfer out a patient [Patient 21] from the emergency room. That their [Hospital 2] has a hard stop in their workflow and he [Physician 1] does not accept patient from [Hospital 1].

During an interview on 6/13/2023, at 4:52 p.m., with Physician 1, Physician 1 confirmed he had been on call on 5/10/2023.

During an interview on 6/13/2023, at 7:03 p.m., with hospital 2's TCS 2, TCS 2 stated, "When Physician 1 is on he does not want to take patients from [Hospital 1].

During a review of Hospital 2's "Urology Call Schedule" (UCS), dated April 2023, the "UCS" indicated [Physician 1] was on call Monday, April 10th (2023). Call coverage begins at 7:00 p.m. to 7:00 a.m. the following morning."

During a review of Hospital 1's record "Patient 21's Case Summary" (PCS), dated 4/11/2023, the "PCS" indicated, "22:36 (10:36 p.m.) Hospital 2's [Transfer Center Staff 2] called from [Hospital 2]; states (sic) that she cannot accept transfer due to on call Urologist (is a medical doctor specializing in conditions that affect the urinary tract) dr [Physician 1] not accepting urology patient from [Hospital 1]; asked if that is [Hospital 1] specifically and [Transfer Center staff 2] states that it is [Hospital 1] specifically and that it is written into their workflow. At 22:50 PM (10:50 p.m.): spoke to TCS 3 in the transfer center, asked for clarification as to why they don't accept patients from [Hospital 1], states that [Physician] is on call from 04/10-40/16 (sic) and it is written that they are not to accept patients from [Hospital 1] or [Hospital 3]. When asked for clarity as to why they are unsure. . . Placed on hold and when back on the line states he spoke with his manager and states that theyre (sic) now denying because they don't have the services."

During a review of Hospital 2's document titled, "Facility Communication" (FC), dated 4/10/2023, at 22:34 (10:34 a.m.), the "FC" indicated, "[Physician 1] is on from 4/10-4/16 Per workflow: [Physician 1] will not accept transfer from [Hospital 1] or [Hospital 3] with the exception of insurance transfers. When [Physician 1] is on call, please decline urology cases from [Hospital 1] and all [Hospital 3] facilities for services not available. No need to escalate these declines." At 22:34 (10:34 p.m.), "Informed [TCS 1 that per workflow, we are not accepting HLOC (higher level of care) [Hospital 1] Transfers when [Physician 1] is on."

During a review of Hospital 2's document titled "Workflow" undated, the "Workflow" indicated, "Urology. . . When [Physician 1] is on call, contact him to determine if transfer is appropriate prior to contacting the hospitalist. [Physician 1] will not accept transfer from [Hospital 1] or any [Hospital 3] facilities When [Physician 1] is on call, please decline urology cases from [Hospital 1] and all [Hospital 3] facilities for services not available. No need to escalate these declines."

During a review of the facility policy and procedure (P&P) titled "Emergency Medical Care/Medical Treatment and Labor Act (EMTALA) Corporate Policy," dated 9/25/2018, the P&P indicated," It is also the policy of [health facility] to accept emergency transfers from other facilities if the individual being transferred requires Special Capabilities that are not offered or not immediately available at the transferring hospital provided that the [health facility] hospital has the Capacity and Capability to treat the individual."