HospitalInspections.org

Based on interviews and patient medical record reviews the facility failed to ensure that individual(s) responsible for providing continuing care (an Assisted Living Facility) were provided discharge instructions for 1 of 8 Emergency Department (ED) patients sampled (Patient #1).

The findings include:

A closed medical record review was conducted for Patient #1. On 09/04/2023, Patient #1 presented to the ED with generalized weakness. The patient was evaluated by a physician who reported the patient stated he was homeless, felt dehydrated and feeling generally weak, tired and fatigued and that the patient was brought in by the sheriff's office as he was walking along Front Beach Road. Despite the patient stating he was homeless, the hospital's patient demographic sheet listed "Person to Notify," as a local Assisted Living Facility (ALF), with address and phone number listed. The history and physical completed, also identified "Social History - LIVES GROUP HOME, ALF." The patient was subsequently evaluated without significant findings; provided comfort measures in which he indicated he felt much better. The physician's clinical impression indicated "Well Adult Health Check." The patient was provided discharge instructions and proceeded to walk out of the Emergency Department on 9/04/2023 at 11:50 AM. There was nothing documented if the ALF was notified when the patient arrived to the ED or when he was discharged from the ED.

On 10/02/2023 at approximately 03:00pm an interview was conducted with Staff Member G, a Registered Nurse (RN) and the Vice President of Quality (VPQ) regarding Patient #1. Staff Member G stated that Patient #1 arrived at the ED via EMS (Emergency Medical Services) after Law Enforcement contacted them. She added, we have a lot of homeless patients here due to our location to the local bus station. Staff Member G said, the patient's face sheet is not looked at routinely as it is completed electronically by remote registration staff. She stated that Patient #1 had good care at the facility, staff provided him with food, drinks and let him rest for some time before completing the discharge process; a ride was offered and refused by Patient #1. This was not documented in the record.

On 10/02/2023 at approximately 03:47pm an interview was conducted with Staff Member C, an RN and Charge nurse. Staff Member C stated she was here when Patient #1 was treated. We gave Patient #1 food, drinks and let him rest here. Once Patient #1 was ready to leave, we offered a ride as we can get taxi's/Uber's for the patients and especially homeless people. Patient #1 didn't want a ride anywhere and was discharged. Staff Member C was not aware that Patient #1's home was listed on the admitting facesheet, and that he resided at an ALF. She stated that staff are busy with care and don't usually look at the facesheet, however, knowing this information was available on the facesheet could have made a difference had we known about the ALF, we could have called them.

On 10/02/2023 at approximately 04:04pm an interview was conducted with Staff Member F, a physician. Staff Member F stated that he was aware that Patient #1 had listed the ALF as his home address, but stated the patient denied living at the ALF and stated he was homeless. The patient was alert. Staff Member F added, we do offer our patients ambulance transfer back to their facility or taxi/Uber rides for other people. I remember patient #1 said he didn't have an address to go to. We kept Patient #1 longer than normal; gave him food, Gatorade, let him sleep for a bit - it was Labor Day and we were not very busy and could let him stay longer than needed. Staff Member F added, we all provided good care for patient #1; staff offered him a ride home and this was refused - not sure if this was documented by nursing.

On 10/03/2023 at approximately 08:05am an interview was conducted with Staff Member B, a Registered Nurse and the ER (Emergency Room) Manager. Staff Member B stated that Patient #1 was treated in our ER on 09/04/2023. Staff let the patient sleep in the room; provided him with food and fluids before he was discharged. Staff Member B stated the patient was offered a ride and he refused. Staff Member B stated that this is not something her staff routinely document in the record. Staff Member B, did state that the discharge nurse, Staff Member A, had called her about how to call for a taxi/Uber for this patient. Staff Member B stated, "ER nurses don't document as well as they should when it comes to some services we offer. I have told them we need to document better and capture everything we ever offer the patient/family even if they refuse it".

On 10/03/2023 at approximately 10:00am an interview was conducted with Staff Member G(RN/VPQ) and Staff Member H , a Registered Nurse and the Chief Nursing Officer (CNO).
Staff Member G said, I knew patient #1 had been here as it was identified by the media on 09/18/2023 as a missing person. Staff G added, at that time, we did not have any concerns with his care. Staff Member H added, when we spoke with the ER staff, they all confirmed Patient #1 stated he was homeless and was given care and offered a ride to any location but he refused the ride at discharge. Both Staff Member G and Staff Member H verified that staff did not document that information. Staff Member G added, the ALF was listed as patient #1s home on the face sheet, that seems to be the disconnect in communication for discharge, no one verified with the ALF if the patient was still a resident at the facility.

On 10/03/2023 at approximately 11:50am a telephone interview was conducted with Staff Member A, a Registered Nurse and the discharge nurse for Patient #1. Staff Member A stated she reached out to Staff Member B (the ER Manager) to get an Uber for Patient #1; but Patient #1 refused the ride. I did not know that Patient #1's home was listed as an ALF; I did look at the face sheet but there is so much on it. Staff Member A denied calling the Assisted Living Facility (ALF).

On 10/03/2023 at approximately 01:55pm an interview was conducted with Staff Member B (RN and ER Manager), Staff Member G (RN/VPQ), and Staff Member H(RN/CNO). Staff Member B stated that case management has resources available for homeless people and is provided on a case by case basis. Staff Member B added, we have a list of community resources we can use and give to the patient if requested Staff Member B said, we send discharge paperwork to the receiving facility and if a nursing home, we call a report - sometimes they call us first. Staff Member B added, with an ALF, we send the patient back with typical discharge paperwork unless they ask us to send it to the facility. Memory care patients will come in by EMS and they give us a 'heads up' first and call a report and we call them back before discharging. Staff Member B identified a 'safe discharge' as offering the patient a ride, a meal, resources, and if the patient is interested - they call me, and Case Management (CM) in the hospital's Main ER as a resource. Staff Member B added, patients can refuse care/services, it is their 'right' but that staff need to communicate with the ALF and let them know about the patient and verify they are still a resident and document this. Staff Member H added - sometimes the registration is done later in the care process, and staff ask if the address is the same, and take the patient's word.

On 10/02/2023 the facility policy and procedure entitled "Plan for Providing Patient Care," PolicyStat ID 12943715, approved 01/17/2023 was reviewed. Noted on pages 12-13, part "XIV - Discharge Planning," indicates "Hospital assists the patient and/or significant other in planning for discharge, identifying after care needs, and/or arranging for alternative care settings. Discharge planning is addressed as part of the interdisciplinary process of care. Each patient's/family's needs for post-hospital care are assessed, identified and addressed beginning on admission. Discharge planning includes assessment and intervention to meet the ongoing health care needs including - Physical limitations - Financial needs - Psychosocial needs - Behavioral needs - Educational needs - Pain management needs. Safety needs - The plan for meeting the patient's needs may include, but is not limited to: Home Health Nursing - Supplying durable medical equipment - Home oxygen - Alternative care settings. Assessment of home environment -- Support is supplied by community agencies. Acute transfers for services not provided. The hospital facilitates the continuum of care by communicating appropriate patient information to the receiving facility and/or outside resource. The discharge summary for admission, the treatment rendered and the response to that treatment, the physical and psychosocial status at the time of discharge, progress towards achieving goals, the reasons for transfer/referral and instructions or referrals provided to the patient/family are summarized by attending physician. Policies and procedures for organizational discharge planning are developed in collaboration with all disciplines. The organization provides staff to support the collaboration of Discharge Planning through the Case Managers and Social Workers in the Case Management Department.