HospitalInspections.org

Based on interviews, medical record review, review of Case Management Notes, and review of policy and procedure, the hospital failed to attempt to locate shelter for Patient Identifier (PI) # 1, when prior placement arrangements became unavailable. Staff also failed to notify the patient's physician about the change in post discharge plans. This affected PI # 1, one of 11 sampled patients.

Findings Include:

PI # 1's Medical Record Review:

A review of the Discharge Summary revealed the patient was admitted to the hospital with bi-mandibular fracture post assault. Surgery was done and the patient's jaw was shut with wire. The patient has disposition issues since he does not have a place to live. He developed pneumonia. Levaquin was started and the patient improved. The patient was discharged on antibiotics.

Case Management (CM) / Care Coordination Notes:

8/27/15 Case Management Screening: High Risk Indicators - Homeless, multiple comorbidities, suicide/alcohol.

Note: Altercation - mandibular fractures. Homeless - lives on the streets. Referred to Salvation Army. Surgery scheduled today. Anticipate discharge tomorrow.

8/28/15: ORIF (Open Reduction Internal Fixation) Left mandible 8/27/15. Bed available at Salvation Army.

9/1/15: Developed pneumonia. IV (Intravenous) AB (Antibiotic) started yesterday. Salvation Army had bed last Friday. Referred to Wellness Coalition...

9/2/14: Patient informed case manager he/she no longer allowed at Salvation Army. No beds available at (name of another local mission).

9/2/14: Call to 211 (City Information Center). Referred to New Life.

9/2/15: MD (Medical Doctor) not comfortable discharging patient to streets- jaw wired shut. Notified Care Coordination Manager. Message left for staff at New Life; awaiting return call.

9/3/15: Spoke with staff at New Life - Referred to (name of staff). Message left; awaiting return call. Verified patient could not return to Salvation Army.

9/4/15: Patient ready for discharge. Provided cab ride, clothes and medication will be filled at (name of pharmacy). Patient advised he/she will find some place to go from City Drugs.

Policy: Case Management
Care Coordination - Discharge Planning Effective Date: 7/8/15

...IV. 1. The Care Coordinator will assess the patient's clinical acuity, personal...and financial resources for the purpose of developing an effective, cost efficient plan for moving the patient to the most appropriate level of service on the continuum of care.
c. Current community resources...

2. The discharge plan shall be the product of the interdisciplinary team, which may include but is not limited to the patient...patient's physician, dietician, nursing, pharmacy...

Interviews:

Interview with Employee Identifier (EI) # 1/ RN Case Manager, on 10/5/15 at 12:50 PM:

According to the Case Manager, scrubs were provided by the hospital because the patient had no clothes. When asked where the patient was discharged the manager said, "(name of pharmacy). I asked him where he wanted to go after discharge. He said he would figure it out." Prior to this admission, the patient said he lived with a friend. The Case Manager said the patient, "Refused my offer to be sent there (friend's residence) via cab." (This information was not documented in the medical record).

Interview with Employee Identifier (EI) # 2/Interim Director Care Coordination, on 10/6/15 at 11:30 AM:

The Director stated the case manager should have notified the physician about the inability of staff to find placement for the patient. The Director also said the case manager's documentation was not satisfactory.

The patient, identified by staff as high risk at discharge due to lack of shelter and comorbidities, including a psychiatric history and alcohol use, was discharged without a plan for physical shelter. Staff failed to notify the physician that the discharge plan for the patient's placement changed prior to discharge.