HospitalInspections.org

50304

Based on interview and record review, the facility failed to implement their discharge policy, for one of 30 sample patients (Patient 20), when Patient 20 was unsafely discharged without receiving services for a homeless patient.

This failure had the potential to contribute to Patient 20 subsequently being struck by a car after the unsafe discharge and eventually expiring.

Findings:

On January 27, 2025, at 2:41 p.m., a review of Patient 20's medical record was conducted with the Emergency Department Director (EDD). The "History and Physical," dated January 18, 2025, indicated Patient 20 was seen in the Emergency Department on January 18, 2025, for general weakness with past medical history of Diabetes mellitus (a chronic disease that causes high blood sugar levels) and hypertension (high blood pressure).

On January 28, 2025, at 2:24 p.m., a review of the facility document titled, "[Name of facility] Triage [the process of sorting and organizing patients in order to determine the urgency of their need or treatment] Report," dated January 18, 2025, at 8:50 p.m., indicated, "...homeless female biba [brought in by ambulance] for weakness to BLE [bilateral lower extremity] from walking..."

The untitled facility document, creation date, January 18, 2025, at 9 p.m., was reviewed and indicated, "...homeless who was brought by paramedics complain of generalized weakness from walking so much...social history: ...unemployed homeless..."

On January 28, 2025, at 2:25 p.m., a telephone interview was conducted with the Doctor of Medicine (MD). The MD stated he saw Patient 20 on January 18, 2025, in the Emergency Department (ED). The MD stated Patient 20 was homeless.

On January 28, 2025, at 2:24 p.m., an interview was conducted with the EDD. The EDD stated there was no documented evidence Patient 20 was offered a meal, patient had weather appropriate clothing prior to discharge, transportation to their discharge location within 30 miles or 30 minutes was offered, and a list of resources that are available in the area was provided. The EDD stated these should have been provided to Patient 20, and documented in the medical record.

On January 28, 2025, at 4:03 p.m., a telephone interview was conducted with the Registered Nurse (RN). The RN stated she triaged Patient 20 on January 18, 2025, and that Patient 20 was homeless. The RN further stated she was the one that discharged Patient 20 on January 19, 2025. The RN stated she did not provide the homeless discharge services for Patient 20, at the time of discharge.

A review of the facility document titled, "Discharge Assessment/ Summary Report, dated January 18, 2025, indicated, "...Patient Departed from the ED date and time 01/19/2025 01:49 [January 19, 2025, at 1:49 a.m.] ...Discharge Disposition...home..."

A record review was conducted with the EDD on January 28, 2025. The facility policy and procedure titled, "Discharge of Homeless Patient," dated August 2024, indicated, " ...Each homeless patient will be offered the following services prior to discharge and documented in the patient's medical record: ...the social worker (or if one is not available the nurse) will provide to the patient a list of resources that are available in the area...prior to discharging the homeless patient they will be offered a meal...the hospital is responsible for assuring that the patient has weather appropriate clothing prior to discharge...the homeless patient will be offered vaccinations...the homeless patient will be offered transportation to their discharge location within 30 miles or 30 minutes of the hospital this will be documented on the discharge assessment..."