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A. Based on a review of Hospital policy, a review of Connect referral recording, medical record review, and staff interview, it was determined the Hospital failed to ensure all patients requiring specialized psychiatric care, which this Hospital provides, were accepted for transfer to its Hospital, when capacity and staffing allowed acceptance. Please see deficiencies at A 2411.

A. Based on a review of Hospital policy, a review of Connect referral recording, medical record review, and staff interview, it was determined in 1 of 1 (Pt #1)referral forms reviewed, in which the Hospital denied acceptance of a psychiatric patient, the Hospital failed to ensure all patients requiring specialized psychiatric care, of which the Hospital provides, were accepted for transfer to its Hospital when the capacity and staffing allowed acceptance.

Findings include:

1. The policy titled " Criteria for Admission of Psychiatric Patients " was reviewed on 2/16/12. It indicated " Special Instructions: 1. A. 1 ... the patient must have a Psychiatrist who has agreed to accept the patient in his/her service ... II. Reasons for Hospitalization for Patients with Psychiatric Disorders ... B... Indications for active hospital treatment include, but are not limited to the following: 1. Depression with suicidal ideation. 2. History of recent suicide attempt or serious threat or risk of suicide ... "

2. The Connect referral recording for Pt #1 was reviewed on 2/16/12 at 1:00 PM with the Behavioral Health Nurse Manager and the Director of Regional Referral Center. It indicated the Crisis personnel contacted the Connect referral program concerning Pt #1. The Connect Operator then contacted the Psychiatric unit to find out what the bed availability was. There was one female and one male bed on the Acute (South) unit. The on-call Psychiatrist was then contacted, the information was conveyed, and the Psychiatrist was connected to the Crisis personnel. The Crisis personnel reported that Pt #1 "had suicidal ideation...
Was positive for cocaine and marijuana at this time... The Psychiatrist then indicated "Sounds like Pt #1 needs to go to a drug treatment program."" The Crisis personnel told the Psychiatrist that "no one will take Pt #1 if Pt #1 is suicidal and is high risk." The Psychiatrist then indicated would check with the nursing staff and call back... the charge nurse indicated they had one female and one male acute bed open..." Then the Psychiatrist instructed the Connect Operator to " Please let them know we won ' t be taking this patient. "

3. The medical record of Pt #1 from the transferring hospital was reviewed on 2/16/12. Pt #1 presented to the transferring hospital on 1/7/12 with the chief complaint of rash and hives. Crisis personnel documentation indicated Pt #1 had a plan to slit wrists with a knife and had threatened to utilize a carpet knife in the past to kill self. The certification for transfer indicated "continues to insist that if had knife would kill self." Crisis personnel documentation indicated "Pt #1 was high risk due to a plan, means and intent."

4. The medical record of Pt #1, from the hospital that did accept the referral was reviewed and indicated that Pt #1 was admitted to their hospital on 1/8/12 at 1:20 AM with the diagnosis Mood Disorder, not otherwise specified (NOS), Drug Use and Abuse.

5. During a staff interview, conducted with the Chief Operating Officer, the Emergency Department Service Line Administrator, and the Behavioral Health Nurse Manager on 2/16/12 at 3:15 PM, the above findings were confirmed.