HospitalInspections.org

Based on record review and interview, the facility failed to ensure that each patient is informed in advance of hospital discharge, in 1 of 10 sampled patients (Patient #2) reviewed for patient rights.

Findings include:

Record review of Patient #2's "Intake Assessment" dated 10/20/14 at 9:42 a.m. indicated admission to out-patient PHP (Partial Hospital Program) for Depression and Suicide Ideation without plan or intent, with symptoms of decreased ability in thinking, concentration and decision-making.

Record review of Patient #2's medical "Psychiatric Assessment" conducted on 10/21/14 at 2:25 p.m. by Psychiatrist A documented patient will have out-patient treatment for 10 days (6 days/week) for affect tolerance, mindfulness and disease specific psycho-education.

Record review of Patient #2's medical "Psychiatry Discharge Summary" dated 10/27/14 at 12:44 p.m. and written by Psychiatrist A indicated that patient feels that program is of no benefit, and is looking into 10/28/14 evaluation at another hospital. This summary documented that patient is having "issues with therapist B" and being disruptive in group setting. Psychiatrist A documents "At this point it is not therapeutic for this patient to come on Saturday (10/25/14) since the lead therapist (B) is the one (patient) has issues with (sic) is refusing to address the reasons behind (patient's) dissatisfaction and anger...Patient was asked to take therapeutic break for Saturday (10/25/14) and did not return to programming on Monday (10/27/14) and thus was discharged to out-patient services."

Patient #2's 12/16/14 medical record review of the the hospital's "AVS (After Visit Summary)" printed 10/27/14 at 1:38 p.m. indicated that "patient is unavailable to sign-mailed to patient's home".

During an interview with Quality Director C on 12/16/14 at 1:30 p.m., C revealed that the "AVS" is the discharge instruction document that is given to the patient upon discharge from hospital.

During an interview with Psychologist D on 12/16/14 at 1:35 p.m., D was asked to provide any documented evidence that the facility made attempted contact with Patient #2 to inform patient of pending discharge before 10/27/14 at 12:44 (date and time of discharge by Psychiatrist A). As of 12/22/14, the facility had not submitted any additional information.

During an interview with Patient #2 on 12/19/14 at 3:13 p.m., Patient #2 stated that "I received a letter a few days later after my last day there (10/24/14) stating I had been discharged from the program. They didn't contact me to see if I had adequate aftercare or a safety plan in place."

Based on record review and interview, the facility failed to ensure that patients who need counseling for post hospital care were given counseling prior to hospital discharge, in 1 of 10 sampled patients (Patient #2) reviewed for discharge planning.

Findings include:

Record review of Patient #2's "Intake Assessment" dated 10/20/14 at 9:42 a.m. indicated admission to out-patient PHP (Partial Hospital Program) for Depression and Suicide Ideation without plan or intent, with symptoms of decreased ability in thinking, concentration and decision-making.

Record review of the "Partial Hospital Program Symptom Rating Scale" completed by Patient #2 on 10/20/14 revealed the following rating of symptoms experienced (rating scale is 0=no symptoms to 10 =most intense symptoms):
"Indecision =5,
Lack of Emotional Support=10,
Sleep problems =6,
Suicidal Ideation =8,
Urge to harm self =5".

On 10/24/14, Patient #2's last day of PHP therapy, the patient's self-rated scores were:
"Indecision =4,
Lack of Emotional Support=5,
Sleep problems =4,
Suicidal Ideation =4,
Urge to harm self =4".

Record review of Patient #2's medical "Psychiatry Discharge Summary" dated 10/27/14 at 12:44 p.m. and written by Psychiatrist A indicated that patient feels that program "is of no benefit, and is looking into 10/28/14 evaluation" at another hospital. This summary documented that patient was having "issues with therapist B" and being disruptive in the PHP group setting. Psychiatrist A documented "At this point it is not therapeutic for this patient to come on Saturday (10/25/14) since the lead therapist is the one (patient) has issues with (sic) is refusing to address the reasons behind (patient's) dissatisfaction and anger...Patient was asked to take therapeutic break for Saturday (10/25/14)and did not return to programming on Monday (10/27/14) and thus was discharged to out-patient services."

There is no documented evidence that the hospital attempted contact with Patient #2 to determine why patient failed to return to the partial hospitalization behavioral therapy program on 10/27/14, even though self-reported scores documented moderate symptoms of suicide ideation with and urge to self-harm. There was no documented evidence that the facility attempted to assist Patient #2 with transfer to another hospital's out-patient treatment program.

Record review of Patient #2's "AVS (After Visit Summary)" also known as the discharge instruction information sheets printed 10/27/14 at 1:38 p.m. indicated that "patient is unavailable to sign-mailed to patient's home". This 3-page AVS identified patient's discharge medications, future PHP appointments at the facility even though patient had been formally discharged from this program and instructions for followup appointments: therapist appointment on 11/17/14 at 11:15 a.m. and medication management (to be arranged by patient). There is no documented evidence of a "Safety/ Prevention Plan" being developed, before discharge, with and/or for this patient to identify triggers that could cause an increase in adverse symptoms. There is no documented evidence of a "Safety/ Prevention Plan" being developed, before discharge, with and/or for this patient to identify coping skills needed to deal with negative thoughts, painful feelings or self-harm urges.

During an interview with Psychologist D on 12/16/14 at 1:35 p.m., D was asked to provide any documented evidence that facility made attempted contact with Patient #2 to inform patient of pending discharge before 10/27/14 at 12:44 (date and time of discharge by Psychiatrist A). As of 12/22/14, the facility had not submitted any additional information.

During an interview with Patient #2 on 12/19/14 at 3:13 p.m., Patient #2 stated that "I received a letter a few days later after my last day there (10/24/14) stating I has been discharged from the program. They didn't contact me to see if I had adequate aftercare or a safety plan in place."