HospitalInspections.org

Based on medical record review, document review and interview, the hospital failed to ensure compliance with 489.24 in that the hospital failed to accept an appropriate transfer of a patient (#01) requiring the hospital's specialized capabilities.

Findings include:

1. Please see findings cited at 489.24(f)

Based on medical record review, document review and interview, the facility refused to accept from a referring hospital an appropriate transfer of an individual (#01) who required specialized capabilities.

Findings:

1. Review of medical record for patient #01 from transferring hospital (facility #1) indicated the following:

a. The patient was brought to facility #1 via ambulance after a motor vehicle accident on Thursday 1/20/11. He/she arrived at 3:50pm and was triaged as urgent.
b. x-ray of right forearm indicated there was a comminuted fracture of the distal radius...
c. x-ray of right lower leg indicated the tibiotalor joint appeared subluxed and there was questionable fracture of the distal fibula.
d. Clinical Impression on emergency record indicated open fracture radius.
e. physician order sheet/additional progre: indicated a call was made to facility #2 at 1952 for orthopedic on call. On call orthopedic physician did not accept patient. Progress record addendum indicated on call physician for facility #2 stated not on call for trauma for
facility #1

2. Staff member #A1 at facility #1 indicated in interview on 2/9/11 at 10:40am that orthpedic surgeons are at the facility for surgery on Monday, Tuesday, Wednesday and Friday. They are not on call.

3. Review of orthopedic on call list at facity #2 indicated MD #2 was on call on 1/20/11

4. Interview with MD#2 at facility #2 on 2/9/11 at 1:30pm indicated the following:
a. He/she received a call from a physician at facility #1 requesting the transfer to ortho. No details other than the patients age were given. He/she refused the transfer and indicated that his/her big issue was that facility #1 advertises advanced orthopedic care and fracture care.
b. MD #1 called him/her to discuss the issue. He/she then called MD at facility #1 and at that point he/she was informed that it was an open fracture.
c. He/she did not consider this an emergency medical condition and has had patients with open fracture that did not have surgery immediately