HospitalInspections.org

Based on interview and record review, Hospital A did not comply with 489.24 (e) (1)-(2). in that the hospital failed to provide a social work evaluation for possible transfer to a psychiatric hospital prior to discharging of 1 of 1 patient (Patient #20) to police custody on 1/20/15. Patient #20 was taken to Hospital B by police and admitted to Hospital B on 01/20/15 with the diagnoses of Major Depressive Disorder (MDD). Hospital A did not initiate a transfer with Hospital B to meet Patient #20's psychiatric needs.

Findings included:

Patient #20 with a police officer presented in the Emergency Department (ED) of Hospital A on 1/20/15 for "intentional ingestion" of 30 pills "Xanax." Attending physician's (Physician #6) History and Physical indicated Patient #20 had access to a gun. Physician #6 ordered a social worker consultation at 12:26 AM for possible transfer to a psychiatric facility. Patient #20 was medically discharged to police custody at 2:07 AM without being seen by a social worker and/or clinician (1 hour and 41 minutes after the order was made). Patient #20 had no "MAT (Mobile Assessment Team-Crisis Clinician)" evaluation for transfer to another hospital.

Patient #20's medical record indicated a late entry by a nurse on 1/20/15 at 3:25 AM "Received call from (Hospital B) requesting a copy of Pt's chart, Received authorization to release...faxed patient care summary to (fax number of Hospital B). "

The Medical Record (MR) from Hospital B indicated Patient #20 presented to Hospital B on 01/20/15 at 2:39 AM. The 2:42 AM triage assessment indicated the admission was involuntary with "APOWW (Peace Officer Application for Emergency Detention Without Warrant)" from the police. The notes reflected: "Tell me why you came here to the hospital today: Per APOWW patient took OD (overdose) on 30 Xanax. Patient was cleared discharged from (Hospital A) to police." Patient #20 was admitted to Hospital B for MDD (major depressive disorder) on 01/20/15.

In an interview with Personnel #1 in the administration conference room of Hospital A on 1/28/15 at 1:55 PM and on 1/29/15 at 11:54 AM via phone:
Personnel #1 was asked what the time frame was for a social worker to respond when a physician's order was activated. She replied per policy the social worker and/or clinician must be in the facility in an hour after he or she was informed of the order.

Personnel #1 was asked when the social worker was notified of the social worker consult order. Personnel #1 stated there was no documentation in the MR (medical record) about the notification.

Personnel #1 was informed that in Patient #20's MR the physician order for social worker consult was made at 12:26 AM. Patient #20 was discharged at 2:07 AM to police custody. After 1 hour and 41 minutes, from the time of the order to patient discharge, no social worker and/or clinician visited Patient #20. Personnel #1 agreed.

In a phone interview with Physician #6 from Hospital A on 1/30/15 at 1:36 PM, he was asked if Patient #20 needed to be transferred to a psychiatric facility. He replied "I do believe he needed psychiatric help. He had access to a gun and he took 30 pills of Xanax." Physician #6 explained that a social worker consult was ordered. The social worker and/or the clinician was responsible for expediting patient transfers. Physician #6 was asked if a social worker saw the patient prior to discharge. He replied "no."

"Mobile Assessment Policies" issued 2/2014 required "Provide timely and appropriate assessments in all...facilities ...When called; clinician will return call within 15 minutes and arrive location within 60 minutes of assessment call time."

Based on interview and record review, Hospital A did not provide an appropriate transfer for 1 of 1 patient (Patient #20) who presented in the Emergency Department (ED) on 1/20/15, in that a social worker did not respond to Physician #6's order for a social worker consult for a possible transfer of Patient #20 to a psychiatric facility. Patient #20 was discharged to police custody and taken to Hospital B without Hospital A's involvement in the transfer until after Hospital A was contacted by Hospital B for the medical record information. Patient #20 was admitted to Hospital B on 01/20/15 with MDD (major depressive disorder).

Findings included:

Patient #20 with a police officer presented in the Emergency Department (ED) of Hospital A on 1/20/15 for "intentional ingestion" of 30 pills "Xanax" and alcohol intoxication. The attending physician's (Physician #6) History and Physical at 12:25 AM indicated Patient #20 had access to a gun. At 12:26 AM Physician #6 ordered a social worker consultation. Patient #20 was medically cleared and discharged to police custody at 2:07 AM without being seen by a social worker and/or clinician. Patient #20 stayed one hour and 41 minutes in the ED after Physician #6 ordered a social worker consultation through the "MAT (Mobile Assessment Team-Crisis Clinician)."

Patient #20's medical record indicated a late entry by a nurse on 1/20/15 at 3:25 AM that included: "Received call from (Hospital B) requesting a copy of Pt's chart, Received authorization to release...faxed patient care summary to (fax number of Hospital B)."

The Medical Record (MR) from Hospital B indicated Patient #20 presented to Hospital B on 01/20/15 at 2:39 AM. The 2:42 AM triage assessment indicated the admission was involuntary with "APOWW (Peace Officer Application for Emergency Detention Without Warrant)" from the police. The notes reflected: "Tell me why you came here to the hospital today: Per APOWW patient took OD (overdose) on 30 Xanax. Patient was cleared discharged from (Hospital A) to police." Patient #20 was admitted to Hospital B for MDD (major depressive disorder) on 01/20/15.

In an interview with Personnel #2 in the administration conference room of Hospital A on 1/28/15 at approximately 1:00 PM and on 1/29/15 at approximately 2:15 PM via phone call:
Personnel #2 was asked if the ED had 24 hour social worker service. She replied they have a social worker that worked during the weekday. During the week nights and weekends, the facility had a "MAT" team. The MAT team covered the facility and other sister facilities.

Personnel #2 was asked to verify the activation of the MAT clinician on 1/20/15 for Patient #20. She confirmed it was at 12:26 AM. Personnel #2 confirmed there was no documentation as to when the MAT clinician was informed about the physician's order.

In a phone interview with Physician #6 from Hospital A on 1/30/15 at 1:36 PM, he was asked if Patient #20 needed to be transferred to a psychiatric facility. He replied "I do believe he needed psychiatric help. He had access to a gun and he took 30 pills of Xanax." Physician #6 explained that the social worker consult was ordered and that the social worker or clinician was responsible for expediting patient transfers. Physician #6 was asked if a social worker saw Patient #20 prior to discharge. He replied "no." Physician #6 was asked if he knew where the police officer was taking Patient #20. He replied "no, the patient might be taken to a jail or another facility."

"Mobile Assessment Policies" issued 2/2014 required "Provide timely and appropriate assessments in all...facilities ...When called; clinician will return call within 15 minutes and arrive location within 60 minutes of assessment call time."