HospitalInspections.org

Based on clinical record and Medical Staff Bylaws Rules and Regulations and staff interview it was determined that the facility failed to comply with Medical Staff Bylaws requirements for consultations for one (#1) of four records reviewed. This practice may result in delay in necessary treatment modalities for patients.

Findings include:

Patient #1 presented to the Emergency Department (ED) on 9/29/10 at approximately 11:00 p.m. with hematuria and anemia. The ED physician consulted with the patient's primary care physician who determined the patient should be admitted and a urology consultation requested. The ED physician ordered a urology consult as part of the admitting orders. A nurse made a notation on the order that the urologist was not available until 10/4/10.

Review of the dictated history and physical at 6:30 a.m. on 9/30/10 revealed the plan of care included consultation with a urologist. There was no indication that the consult could be postponed until 10/4/10. Physician verbal order on 9/30/10 at 8:50 a.m. instructed to consult the urologist regarding changing the urinary catheter. There was no documentation that the physician was notified that the urologist was not available until 10/4/10.

The primary care physician's associate assumed responsibility for the patient on 10/1/10. The physician documented that urology was not available. The physician did not document the consult would be completed on 10/4/10 or that the delay was acceptable.

The patient was transferred to another hospital on 10/2/10 due to urology not being available. This represented a 3 day delay in obtaining the ordered consult and potential treatment.

The Medical Staff Bylaws and Rules and Regulations dated June 2010 were reviewed. They require that a consult be completed within 24 hours or within a period of time agreed upon by the physicians involved. They require that if the physician who is consulted is unwilling or unable to perform the consult, it defaults to the on call physician. Review of the physician on call schedule showed the urologist who was consulted was listed as being on call.

During interview on 10/28/10 at approximately 1:45 p.m., the Risk Manager stated that the physician had not been available over the weekend in question. She confirmed that it was not clear whether or not the attending physician was aware on 9/30/10 that the urology consult could not be done until 10/4/10 and if the delay of 5 days was acceptable.