HospitalInspections.org

Based on document review and interview, it was determined that for 1 of 1 (Pt. #1) patient records reviewed for a plan of care, the Hospital failed to ensure the patient and patient representatives rights to participate in the development and implementation of the plan of care.

Findings include:

1. On 4/27/2021, the Hospital's policy titled, "Patient Rights and Responsibilities" (revised by the Hospital 10/2020). The policy required, "...B. As a patient of [the Hospital], you have a right to...4. Participate in decision-making processes related to your plan of care."

2. On 4/27/2021, Pt. #1's clinical record was reviewed. Pt. #1 was admitted to the Emergency Department for a psychiatric evaluation with a diagnosis of autism on 2/22/2021 and remains a patient in the Emergency Department as of 4/27/2021 for psychiatric evaluation:

- The Behavioral Health Progress Notes, written by the Attending Psychiatrist /MD #1, dated 3/25/2021, 4/15/2021, 4/19/2021, 4/22/2021, 4/23/2021, 4/24/2021, 4/25/2021, 4/26/2021, and 4/27/2021, included a diagnoses list of autism, medical clearance for psychiatric admission and aggressive outburst.

-The Behavioral Health Progress note dated 4/27/2021 at 2:06 PM (64 days after admission), included, "...Plan: Plan to continue [to] provide care and keep him stable. We will keep him [on] his medication while monitoring for any side effect from it. He will be release[d] to his guardian after court recommendation, staff and social worker will facilitate the stability and discharge to the community."

-The clinical record lacked documentation of a plan of care related to Pt. #1's diagnoses and extended stay in the Emergency Department (64 days).

3. On 4/27/2021 at 2:28 PM, an interview was conducted with the Regional Director of Accreditation (E #5). E #5 stated that the Emergency Department staff do not have the capabilities within the electronic medical record to create a plan of care for patients. E #5 stated that Pt. #1 does not have a care plan.

Based on document review, observation, and interview, it was determined that for 1 of 1 (Pt. #1) patient observed for privacy, the Hospital failed to ensure the right to personal privacy for patients in the Emergency Department (ED) for activities of daily living and personal hygiene.

Findings include:

1. On 4/27/2021, the Hospital's policy titled, "Patient Rights and Responsibilities" (revised by the Hospital 10/2020) was reviewed. The policy required, " ...B. As a patient of [the Hospital], you have a right to ...6. Expect privacy, confidentiality and dignity concerning your medical and/or psychiatric care."

2. On 4/27/2021, Pt. #1's clinical record was reviewed. Pt. #1 was admitted to the Emergency Department for a psychiatric evaluation with a diagnosis of autism on 2/22/2021 and remains a patient in the Emergency Department as of 4/27/2021 for psychiatric evaluation. Pt. #1's clinical record showed that Pt. #1 has remained a patient in the ED for 64 days.

3. On 4/27/2021 from 9:40 AM to 9:59 AM, an observational tour of the ED was conducted. Pt. #1's room included a full size hospital bed, one chair, a bedside table, one television, one laptop, and countertop space for storage filled with Pt. #1's personal items. Pt. #1's room did not have a private bathroom. There was a unisex bathroom four doors away from Pt. #1's room in the same hallway that is utilized by other patients in the ED. There was a staff bathroom equipped with a shower that was located at the far end of an opposite hallway.

4. On 4/27/2021 at 9:45 AM, an interview was conducted with a Mental Health Specialist/Sitter (E #8). E #8 stated that he is frequently the sitter for Pt. #1. E #8 stated that Pt. #1 communicates well and makes his needs known verbally. E #8 stated that Pt. #1 is allowed to occasionally ambulate through the hallway and utilize the shower at the end of the hall and around the corner.

5. On 4/27/2021 at 9:50 AM, an interview was conducted with the ED Manager (E#6). E #6 stated that Pt. #1 has been in the private room in the ED since the 2nd day of admission to the ED. E #6 stated that Pt. #1 utilizes the patient bathroom in the ED hallway. E #6 stated that Pt. #1 verbally communicates his needs and is allowed to utilize the staff bathroom at the end of the hall for daily showers.

Based on document review and interview, it was determined that for 1 of 1 patient (Pt. #1) clinical record reviewed needing psychiatric admission, the Hospital failed to admit or transfer Pt. #1 to a psychiatric unit, as required, to ensure policies and procedure governing medical care provided in the emergency department (ED) was followed.

Findings include:

1. On 4/22/2021, the clinical record of Pt. #1 was reviewed. Pt. #1 was brought to the Hospital's ED on 2/22/2021 after being assaulted by mother and sustained minor scratches to right arms. Pt. #1 has severe autism. The clinical record included:

- MD #1's (attending psychiatrist/physician) psychiatric evaluation dated 2/23/2021 included, " ... (Pt. #1 was) brought in from home for destroying things, having a fight with his mother, and now grandmother would not want (Pt. #1) back ... No insight due to mental illness as well as autism. Does not have aggression during interview, but impulsive ... Mental Status Examination ... Insight and judgment is poor ... Diagnoses ... autistic disorder, intermittent explosive disorder ... Recommendations ... will need to be hospitalized into (psychiatry) for further management ..."

- MD #1's progress note dated 4/15/2021, 4/19/2021, and 4/22/2021 included, " ... Impression and Plan ... Diagnosis list: Autism, Medical clearance for psychiatric admission. Aggressive outburst." However, the clinical record lacked documentation that the Hospital attempted to find inpatient hospital placement for Pt. #1 since 2/24/2021. As of 4/22/2021, Pt. #1 has been in the ED for approximately two months.

2. On 4/23/2021, the Hospital's Rules and Regulations of the Medical Staff in the ED (amended on 9/17/2020) was reviewed and included, "Physician means an individual with an MD (medical degree) or DO (doctor of osteopathic medicine) that is licensed to practice medicine ... a. Admitting Physician: A member of medical staff who gives the order to admit the patient ... b. Attending Physician: A member of the medical staff who is responsible for the supervision of the patient's care ... 2.3. Patient with Psychiatric Diagnosis. Patients with a primary psychiatric diagnosis who meet criteria for admission to a psychiatric unit, should be admitted or transferred as soon as feasible ..."

3. On 4/22/2021 at approximately 1:20 PM on 4/23/2021 at approximately 10:00 AM, telephone interviews were conducted with MD #1 (attending psychiatrist/physician). MD #1 confirmed that he (MD #1) saw Pt. #1 on 4/22/2021. When asked regarding documentation when Pt. #1's need was changed as not needing inpatient psychiatric hospitalization, MD. #1 could not provide the documentation. When clarified the meaning of "Medical clearance for psychiatric admission, " MD #1 stated that Pt. #1 is medically cleared for psychiatric (hospital) admission.

4. On 4/23/2021 at approximately 9:00 AM, an interview was conducted with E #4 (ED Director) and E #6 (ED Manager). E #4 and E #6 stated that MD #1 is Pt. #1's attending psychiatrist/physician. E #4 said that Pt. #1's clinical record indicated that Pt. #1 needs psychiatric admission. E #4 could not show documentation that the disposition from MD #1 to admit Pt. #1 to an inpatient psychiatric admission has changed since 2/23/2021.