HospitalInspections.org

Based on a review of hospital policy "Emergency Medical Treatment and Transfer (EMTT) (revised 06/16); 3 open and 24 closed emergency department records it was revealed that no statement of stability, risk to benefit, or consent was found for patient #13 who was voluntarily transferred for treatment to a psychiatric hospital.

Review of hospital policy EMTT revealed in part, "C. 1. When it is determined that the individual has an emergency medical condition, the Hospital shall: ...b ...transfers of unstabilized individuals are permitted only if the patient requests it after being informed of the risks and benefits, or when a physician, or other Qualified Medical Person in consultation with a physician certifies that the expected benefits to the transfer outweigh the risks of transfer."
Patient #13 was a middle-aged patient who presented in November 2016 with auditory and visual hallucinations and chest pain. Patient #13 had a recent history of psychiatric hospitalization, but had been non-compliant with medications following discharge. Additionally, patient #13 had a positive toxicology screen inclusive of anti-anxiety medications, and narcotics.

A medical screening examination inclusive of electrocardiogram revealed that the chest pain was likely related to panic attacks. The psychiatric assessment by a social worker described paranoia, confusion, and the patient report of not feeling safe in the community. The social worker further documented in part, "Pt requires an inpatient psychiatric admission to provide a safe environment and medication stabilization." The plan for disposition included, "Voluntary admission." Based in the fact that the hospital did not have an inpatient psychiatric unit, the social worker located an appropriate bed for placement at a second hospital.

A Licensed Clinical Professional Counselor (LCPC) wrote in part, "Pt has been accepted at (hospital #2). Pt remains calm and cooperative, and is awaiting transport within the hour."

For each patient transferred, the hospital used a "Patient Transfer Documentation Form (PTDF)" to document the patient acknowledgement of the risk to benefit of transfer, the patient consent for transfer, and the stability of each patient at the time of transfer. The required form was not found in patient #13's record. While record documentation indicated that patient #13 was stable and knew of the impending transfer, no statement in the record revealed that patient #13 was made aware of the risk to benefit of transfer, and no consent was obtained from voluntary patient #13. Therefore, the hospital failed to meet requirements for the transfer of patient #13.