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Based on record review and staff interview it was determined the facility failed to ensure accurate record keeping in relation to the Emergency Department (ED) log. The ED log failed to accurately reflect the disposition of seven (7) out of twenty (20) patients (#4, 7, 8, 10, 12, 14 and 20) by inappropriately documenting the patients were transferred. This has the potential to negatively affect all patients by leaving them with an inaccurate history of their disposition.

Findings include:

1. During the selection of the twenty (20) medical records for review, it was determined seven (7) of these records classified as transferred (#4, 7, 8, 10, 12, 14 and 20), were in fact not transferred. During an interview in the morning of 9/26/11 with the Clinical Director of the ED, she revealed there was a computer problem and when the registration clerks were coding records, if a patient was discharged back to a nursing home or discharged and then sent for a mental hygiene hearing, the clerks were coding these as transfers.

2. Patient #4 presented to the ED on 6/24/11. After a medical screening exam, the patient was discharged to a mental hygiene hearing. The ED log states the patient was transferred.

3. Patient #7 presented to the ED on 7/20/11. After a medical screening exam, the patient was discharged back to the mental health facility. The ED log states the patient was transferred.

4. Patient #8 presented to the ED on 7/28/11. After a medical screening exam, the patient was discharged back to the mental health facility. The ED log states the patient was transferred.

5. Patient #10 presented to the ED on 8/2/11. After a medical screening exam, the patient was discharged back to the nursing home. The ED log states the patient was transferred.

6. Patient #12 presented to the ED on 8/9/11. After a medical screening exam, the patient was discharged back to the mental health facility. The ED log states the patient was transferred.

7. Patient #14 presented to the ED on 8/17/11. After a medical screening exam, the patient was discharged back to the mental health facility. The ED log states the patient was transferred.

8. Patient #20 presented to the ED on 9/18/11. After a medical screening exam, the patient was discharged home. The ED log states the patient was transferred.

Based on review of documents and staff interview, the hospital failed to ensure the on call physician accepted an appropriate transfer in one (1) of one (1) transfer requests (#21), while the facility had the capacity and capabilities of treating the patient. This has the potential to negatively affect all patients needing specialized care by not accepting the transfer and causing a delay in emergency medical treatment.

Findings include:

1. Patient #21 presented to the sending facility on 9/5/11. He had suffered an injury to his right index finger, and needed specialized care. When the sending physician called the recipient hospital, the transfer was refused.

2. During an interview with the VP of Medical Affairs and the On Call Plastic Surgeon in the morning of 9/27/11, they revealed the facility had capacity and capability on 9/5/11. The On Call Plastic Surgeon received report from the Access Coordinator at the transfer center, and after hearing report from her, refused the transfer, stating he would see the patient in his clinic on 9/6/11.

3. During an interview with the On Call Plastic Surgeon in the morning of 9/27/11, he stated the patient's diagnosis was not an emergent situation. Had he known the patient was draining pus from the wound, then it would become an emergent situation, and the patient would need to be seen immediately.

4. During an interview in the afternoon of 9/27/11 with the registered nurse (RN) who was working in the transfer center on 9/5/11, she revealed she did not feel the physicians needed to speak with each other as the on call plastic surgeon didn't act like this was an urgent situation. When questioned as to the policy, she replied "I sensed this wasn't urgent." The RN also stated she did tell the On Call Physician the requesting physician said there was pus draining from the wound.

5. Review of the Hospital Policy titled Transfer Algorithms, last revised 5/28/10, states in part: "Notify the Charleston Area Medical Center (CAMC) physician or the on-call physician based on specialty call guidelines with the information from the referring facility regarding the patient and bed status. Connect the CAMC physician and referring physician in a conference call.

6. During an interview with the director of the transfer center in the morning of 9/27/11, she revealed not all the steps were followed and the physicians should have been connected via conference call to enable an accurate information exchange. She also agreed with the findings.