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Based on interviews, medical record and policy review the facility failed to ensure that documentation in the medical record contained a summary of the risks and benefits of the transfer for 9 of 26 (4, 5, 7, 8, 11, 12, 13, 14, and 15) sampled emergency medical records reviewed; the facility failed to ensure that appropriate certification of transfer forms were completed according to its transfer policy in 9 of 26 Sampled Patients # (4, 5, 7, 8, 11, 12, 13, 14, and 15) as the Emergency Department Attending Physician did not complete the "Physician Certificate Form of Transfer." Additionally, the facility failed to ensure that the receiving facility agreed to accept individuals and provide appropriate medical treatment for five (5) of 26 sampled patients #'s (8, 9, 11, 12, and 13) was transferred without acceptance by a receiving facility.

Refer to tag A- 2409

Based on interviews, medical record and policy review the facility failed to ensure that documentation in the medical record contained a summary of the risks and benefits of the transfer for 9 of 26 (4, 5, 7, 8, 11, 12, 13, 14, and 15) sampled emergency medical records reviewed; the facility failed to ensure that appropriate certification of transfer forms were completed according to its transfer policy in 9 of 26 Sampled Patients # (4, 5, 7, 8, 11, 12, 13, 14, and 15) as the Emergency Department Attending Physician did not complete the "Physician Certificate Form of Transfer." Additionally, the facility failed to ensure that the receiving facility agreed to accept individuals and provide appropriate medical treatment for five (5) of 26 sampled patients #'s (8, 9, 11, 12, and 13) was transferred without acceptance by a receiving facility.

The findings include:


Review of the facility's policy titled, "Transfers from Miami Children's Hospital Facilities Based on Medical Necessity," effective 03/04/14, document that after a medical screening examination (MSE) has been completed and it is determined that the patient's condition requires services not within the capacity and capability of MCH (Miami Children's Hospital), a transfer will be initiated. Patients will not be transferred unless accepted by a receiving facility and accompanied by pertinent medical record. The policy further state that the Attending Physician authorizing the transfer will: obtain an acceptance from the receiving physician and complete the "Physician Certificate Form of Transfer " and the "Physician Certificate of Transfer" form will become a part of the patient's permanent Electronic Health Record.


Review of sampled patients (SP) #4 medical record showed that an adult patient presented to the Emergency Department (ED) with complaint of headache, high blood pressure, and dizziness. On 08/09/14 at 7:53 PM, the patient's blood pressure was reported as 165/97 mmHg (Systolic/Diastolic, millimeters of mercury). The ED Physician Note showed that on 08/09/14 at 9:40 PM, the physician spoke with Hospital #4 admission center to discuss the patient. The ED Physician Note showed that the patient was discharged to Hospital #4. Sampled Patient #4 medical record did not show that a "Physician Certificate of Transfer' form was completed prior to transfer. There was no documentation in the medical records to indicate the risks and benefits of the transfer for patient #4 on 8/9/2014.

On 11/20/14 at 1:49 PM, Staff I, the Pediatric Attending Physician stated that the Transfer (Physician Certificate of Transfer) forms are usually filled out for transfer with the reason for transfer. I don't know why the transfer form (for SP#4) wasn't completed. The nursing staff usually puts the package together.

On 11/19/14 at 11:35 AM, Staff D, a Registered Nurse (RN) stated that when adult patients are being transferred, the Physician Certificate/Consent for Transport forms are completed.

On 11/19/14 at 11:35 AM, Staff E, a R.N. stated that when patient are transferred Consent for Transport form is completed. She stated that the Consent Form specifies the patient name, the hospital the patient is leaving from, the hospital the patient is going to and the reason for transfer.

On 11/19/14 at 12:02 PM, Staff F, a R.N., stated that when patients are being transferred, the nurse completes a Consent for Transfer. The Consent for Transfer goes through the diagnosis, risk and benefits, and name of receiving hospital. The physician fills out the Certificate of transfer/Consent for Transfer and sign.

Review of SP#5 medical record showed that the patient was an adult who presented to the ED for abdominal pain and nausea. The ED Physician Note on 11/04/14 at 9:32 AM noted that the patient required transfer to an Adult ED for further evaluation. The Notes showed that on 11/04/14 at 11:34 AM, patient care was transitioned to Hospital #3. Sampled Patient #5 medical record did not show that a "Physician Certificate of Transfer' form was completed prior to transfer. There was no documentation in the medical records to indicate the risks and benefits of the transfer for patient #5 on 11/04/2014.

Review of SP#7 medical record showed that an adult patient presented to the ED for dizziness and high blood pressure. On 10/20/14 at 8:47 PM, the patient's blood pressure was 176/127 mmHg. The ED Physician Notes on 10/20/14 at 10:03 PM showed that the patient requested to be transferred to Hospital #2. The ED Physician Notes on 10/20/14 at 10:24 PM stated that Fire Rescue was called and the patient was transported to Hospital #2. Sampled Patient #7 medical record did not show that a "Physician Certificate of Transfer' form was completed prior to transfer. There was no documentation in the medical records to indicate the risks and benefits of the transfer for patient #7 on 10/20/2014.


Review of SP#8 medical record showed that an adult patient presented to the ED for chest pain. Social Worker Notes on 08/30/14 at 3:29 PM showed that code blue was called for the patient at the facility. The patient was stabilized and transported by Rescue to South Miami Hospital for further evaluation. The ED Physician Notes on 08/30/14 at 3:57 PM reported a phone call was placed to Hospital #3 to the Charge Nurse and was disconnected. The patient's care was transitioned to Rescue. Sampled Patient #8 medical record did not show that a "Physician Certificate of Transfer' form completed prior to transfer, or acceptance by a receiving facility. There was no documentation in the medical records to indicate the risks and benefits of the transfer and, neither that the receiving hospital had agreed to accept patient #8 on 08/30/2014 to provide appropriate medical treatment.



On 11/20/14 at 2:30 PM, Staff J, Pediatric Fellow, stated, 911(emergency response) was called (for SP#8). We called over there (Hospital #3) and the phone was disconnected. The facility called back and report was given. I was intubating a patient I could not call back. This was not a transfer, 911 was called. When we transfer, we communicate with the accepting physician. If the transfer was hospital to hospital, the form (Transfer Form) would be completed. This was not a transfer because 911 was called. 911 was called because it was quicker to call 911 than to transport which can delay the care if a Cath (catheter) is needed for a heart attack. When 911 is called, the Transfer form does not get completed. We communicate with the receiving facility out of courtesy.


Review of SP#9 medical record showed that an adult patient presented to the ED for chest pain. The ED Physician Notes on 10/19/14 at 6:00 AM showed that the patient was discharged to an adult facility by Miami Dade Fire Rescue for chest pain. There was no documentation of communication with the receiving hospital. Review of the "Authorization Transfer" and the "Physician Certificate of Transfer" form, dated 10/19/14 showed that the patient was transferred by ALS (Advanced Life Support) for chest pain. The form was incomplete and did not document the receiving hospital's name or the name of the accepting physician. There was no documentation in the medical record that the receiving hospital had agreed to accept patient #9 on 10/19/2014 to provide appropriate medical treatment.

On 11/20/14 at 4:30 PM, Staff L, Pediatric Attending Physician, stated that I remember the patient (SP#9). He was transferred by 911 rescue. He had several bypasses in the past. He was stable but I wanted to get him out quickly to get a cardiac cath. We called 911 because the ambulance would take longer. A call was made to [name of hospital #4] Transfer Center. He was routed to [name of Hospital #3] by the transfer center. For 911 transfers, we usually follow the normal pattern of transfer with completion of the Transfer Form. We always make a call to the ER (Emergency Room) to notify them of the transfer. They (Hospital# 3) were aware that the patient was being transferred




Review of SP#11 medical record showed that an adult patient presented to the ED following a fall that occurred 20 minutes ago. The ED physician notes reported that on 08/05/14 at 5: 59 PM, 911 were called and the patient was taken to an adult facility for further evaluation. Sampled Patient # 11 medical records did not show that a "Physician Certificate of Transfer" form was completed prior to transfer, or an acceptance of a receiving facility. There was no documentation in the medical records to indicate the risks and benefits of the transfer or that the receiving hospital had agreed to accept patient #11 on 08/05/2014 to provide appropriate medical treatment.


On 11/20/14 at 2:15 PM, the Clinical Director of the Emergency Department stated that no "Physician Certificate of Transfer" Form could be found for SP #11.


On 11/20/14 at 2:20 PM, Staff H, Pediatric Fellow stated that for patient (SP#11) who is transferred by 911, the transfer form and the consent are completed. I am not 100% sure if there should be communication with the receiving facility.


Review of SP#12 medical record showed that an adult presented to the ED. The ED Physician Notes on 05/19/14 at 6:35 PM reported that the patient complained of altered mental status per employees. The notes further state that the EMS (Emergency Medical Services) was called for immediate transfer to another facility for adult care for possible CVA (cerebrovascular accident). There was no documentation of communication with the receiving hospital noted in the record. Sampled Patient # 12 medical records did not show that a "Physician Certificate of Transfer" form was completed prior to transfer. There was no documentation in the medical record to indicate the risks and benefits of the transfer and, neither that the receiving hospital had agreed to accept patient #12 on 05/19/2014 to provide appropriate medical treatment.

On 11/20/14 at 2:15 PM, the Clinical Director of the Emergency Department stated the Transfer ("Physician Certificate of Transfer") Form for SP#12 could not be found.

On 11/20/14 at 4:05 PM, Staff K, Pediatric Attending Physician (for SP#12) stated, The Transfer form is typically filled out. I don't know where the form for this particular patient (SP#12) is.


Review of SP#13 medical record showed that an adult presented to the ED with chest pain, vomiting, and diaphoresis. The Physician Re-evaluation on 05/27/14 at 1:28 PM, reported that the patient's course was resolved and that EMS was at bedside for transport to adult facility. There was no documentation of communication with the receiving hospital. Sampled Patient # 12 medical records did not show that a "Physician Certificate of Transfer" form was completed prior to transfer. There was no documentation in the medical record to indicate the risks and benefits of the transfer or that the receiving hospital had agreed to accept patient #13 on 05/27/2014 to provide appropriate medical treatment.


On 11/20/14 at 2:15 PM, the Clinical Director of the Emergency Department stated the Transfer Form for SP#13 could not be found.

Review of SP#14 medical record showed that the patient was an adult who presented to the ED with chest pain. The ED Physician Note on 05/08/14 showed that the patient was seen 11:39 AM. The Physician re-evaluation on 05/08/14 at 11:54 AM, stated, " recommends spoke with [name of physician] at [name of Hospital #3] ED who accepts patient. "The patient's medical record showed that patient care was transferred to Fire Rescue to South Miami Hospital. Review of the patient's medical record did not show that a Certificate of Transfer was completed. There was no documentation in the medical record to indicate the risks and benefits of the transfer for patient #14 on 05/08/2014.

On 11/20/14 at 2:15 PM, the Clinical Director of the Emergency Department stated the Transfer Form for SP#14 could not be found.

Review of SP#15 medical record showed that an adult presented to the ED and Triage was completed on 02/18/14 at 3:16 PM. The ED Physician Note on 02/18/14 at 3:48 PM reported that the physician spoke with [name of Hospital #4] Transfer Center. 911 was activated to transfer to [name of Hospital #4]. Charge Nurse is aware. Sampled Patient # 15 medical records did not show that a "Physician Certificate of Transfer" form was completed prior to transfer. There was no documentation in the medical record to indicate the risks and benefits of the transfer for patient #15 on 02/18/2014.

On 11/20/14 at 2:15 PM, the Clinical Director of the Emergency Department stated the Transfer Form for SP#15 could not be found.