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Based on record review, policy review, and interview, the facility failed to comply with the Conditions of Participation outlined in §489.24: the facility failed to provide a certificate of risks and benefits, obtain signed consent, obtain acceptance from the receiving hospital or provide patient records to the receiving hospital for a facility transfer of 1 (#8) of 20 sampled patients. This failure could cause unintended adverse medical consequences for the transferred patient. Findings include:

Patient #8 was transferred to a receiving hospital on 2/21/23. Patient #8 had a dog bite that required an x-ray. The x-ray machine was not functioning, so the patient was transferred in an ambulance with a family member, also a patient, to a receiving hospital. There was no documentation of the sending facility providing risks and benefits to the patient, signed consent, acceptance from the receiving facility or evidence of documentation being sent to the receiving facility. [See C-2409].

Based on interview, record review and policy review, the facility failed to provide a certificate of risks and benefits, obtain signed consent, obtain acceptance from the receiving hospital, or provide patient records to the receiving hospital for a facility transfer of 1 (#8) of 20 sampled patients. This failure could cause unintended adverse medical consequences for the transferred patient. Findings include:

A record review of patient #8's EMR reviewed on 5/16/23, showed, Patient #8 was seen in the emergency department on 2/21/23 for a dog bite on his left hand. Patient #8 received Norco, Toradol, Stadol, Marcaine injection, bandaging and a Tetanus vaccine for his injury. The record showed the x-ray machine was not functioning and the patient required an x-ray. Patient #8 was given discharge instructions from the facility stating he needed to go directly to the Emergency Department at another hospital. The EMR for patient #8 failed to show a certificate of risks and benefits for transfer, failed to show there was an accepting physician at the receiving hospital's Emergency Department the discharge instructions instructed him to go to, and failed to show the patient's records had been sent to the receiving facility.

Review of patient #8's Emergency room note, dated 2/21/23, showed, " ...unable to perform a complete evaluation of the finger due to no xrays. He (Pt #8) has agreed to go to [hospital name] with his family and check in to the ER there for further evaluation and xray. If this is an open fracture, it changes the process of repair and care. If the distal flexor tendon is ruptured, it changes the care process. Its in the pts best interest to go to another facility for further evaluation. Wound was minimally irrigated and dressed with 4x4's. Pt is in agreement with this plan and will ride in the ambulance with his family member that is being transferred. (sic)"

Review of discharge instructions for patient #8, dated 2/21/23, showed, "Ride with your family to the ER in [Hospital Name] check into the ER there for evaluation. Tonight."

During an interview on 5/16/23 at 10:58 a.m., staff member C stated the emergency department had a packet they used to make sure everything was done for a transfer to another facility. The packet had a check list showing the facility required a signed risk and benefit form, the patient's records needed to be sent to the receiving facility, and there needed to be an accepting physician.

Review of a facility Policy, titled Emergency Medical Treatment and Active Labor Law, dated 11/1999, revised 5/2023, showed:
" ...Transfer Procedures.
...2. A physician has signed a certification that, based on the information available at the time of transfer, the benefits of transferring the patient to another medical facility outweigh the risks (the certification must contain a summary of the risks and benefits upon which it is based;
...C. All pertinent records are sent to the receiving hospital.
D. The consent of the receiving hospital to accept the transfer is obtained through the nursing supervisor.
E. The transferring physician or QMP obtains consent from the receiving physician to accept the patient ..."