The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

HOWARD UNIVERSITY HOSPITAL 2041 GEORGIA AVE NW WASHINGTON, DC 20060 July 24, 2015
VIOLATION: CRITERIA FOR DISCHARGE EVALUATIONS Tag No: A0800
Based on medical record review, policy review and staff interview, it was determined the governing body failed to ensure the hospital's discharge planning program complies with standards as evidenced by the failure to include medication review with the patient or representative as part of the discharge planning process.

The findings include:

Howard University Hospital Policy Number: SOC-006-14 entitled Discharge Planning last revised June, 2014 stipulates "PROCEDURES: The following procedures will be routinely implemented: 1. Daily case screening and case assignment of new hospital admissions of patients who meet pre-established risk category criteria; 2. Accept referrals from nurses, physicians, quality assurance staff, ancillary staff, other health providers and community agencies; 3. Participate in the case findings, case consultation, and collaboration with health care providers via interdisciplinary rounds, utilization review and patient care conferences; 4. Provide psychosocial counseling to patients and families who are having difficulty adjusting to or coping with acute chronic illness or pregnancy; 5. Coordinate referrals with community and/or mental health agencies and extended care facilities that provide supportive and rehabilitative services to patient and their families; 6. Administrate, monitor and supervise all casework activities so as to ensure quality of patient care services; to serve as a liaison with all medical system services on the behalf of the patient, family, and/or community."

Review of the Discharge Planning Process on July 23, 2015 at approximately 10:45 AM revealed the hospital had a written discharge planning process. The discharge planning process lacks documented evidence of a process to ensure medication review is conducted with the patient and/or representative.

A face to face interview was conducted on July 23, 2015 at approximately 3:30 PM with the Employee #8 regarding the discharge planning process. The Director stated the social workers are responsible for performing all social service screens, coordination of all post discharge care, and all assessment and referrals. S/he stated the Case Management department is undergoing reconstruction to better be able to meet the discharge planning and transitions of care needs.
VIOLATION: TIMELY DISCHARGE PLANNING EVALUATIONS Tag No: A0810
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review, policy review, and staff interview, it was determined the social workers failed to follow the hospital's established discharge planning policy as evidenced by continued non-compliance with timeliness of discharge planning and screens in two (2) of five (5) records reviewed (Patient #5 and 1).

The findings include:


A. Patient #5 was admitted on July 6, 2015 with diagnoses which include Congestive Heart Failure, Diabetes Mellitus, [DIAGNOSES REDACTED], and Hypertension.

Medical record review conducted on July 22, 2015 at approximately 3:22 PM revealed a Physician Order for "Case Coordination/Social Work STAT ASAP- Home Health Aide" dated July 15, 2015 at 10:38 AM. Review of the Progress Notes revealed the Social Worker documented the completion of the Discharge Assessment on July 22, 2015 on the day of discharge, one (1) week after the STAT request was ordered.

The medical record lacked documented evidence the social worker performed the requested case coordination in a timely manner.

A face to face interview was conducted with the Employee #8 on July 23, 2015 at approximately 3:30 PM. S/he stated the social workers have faced challenges with being able to meet the language of the discharge policy secondary to staffing challenges. When queried about the plan of correction submitted as the result of the previous licensure survey, s/he stated that multiple administrative changes since the last survey impacted the compliance with the written plan of correction. The findings were was reviewed, discussed, and acknowledged at the time of interview.

B. Patient #1 was admitted on [DATE] with diagnoses which include Seizure, Chest Pain, Sickle Cell Disease, Hypertension, Asthma, and Chronic Pancreatitis.

Medical record review conducted on July 23, 2015 at approximately 11:11 AM revealed Multidisciplinary Referral Screen documented on March 26, 2015. In the Social Services section, the hospital staff indicated "no problems identified" . Upon review of the options available for determining social service needs includes "readmit within 30 days". The hospital staff failed to accurately assessment Patient #1's social service needs. As a result of the inaccuracy in the assessment, the social service referral was not generated for further evaluation by the social work team.

A face to face interview was conducted on July 23, 2015 at 11:50 AM with Employee #4. The Director confirmed Patient #1 had been in the hospital on at least two prior occasions in the last 30 days. The findings were reviewed, discussed, and acknowledged.
VIOLATION: TRANSFER OR REFERRAL Tag No: A0837
Based medical record, policy review, and staff interview, it was determined the clinical staff failed to ensure the patient received all discharge instruction to ensure post discharge follow-up (Patient #4).

Patient #4 was seen in the Emergency Department on July 21, 2015 for complaints of Left Facial Abscess and Left Leg Wound.

Medical record review conducted on July 21, 2015 at 11:45 AM revealed a consult documented by the Oral Facial Mandible Service (OMFS). The recommendations included instruction to return to OMFS Clinic on July 23, 2015.

Review of the Exit Care documentation revealed the discharge instructions did not include the follow-up appointment scheduled to return to the OMFS Clinic upon discharge.

A face to face interview was conducted on July 21, 2015 at 11:55 AM with the Staff Nurse regarding discharge instructions and process relative to patient returning to long term care residential facilities. S/he stated that the diagnostic result and discharge summary are copied and sent with patients upon return to the facility. In addition, the hospital nurse places a call to the facility to give report to the receiving facility. When queried about the instructions provided to the patient in preparation for discharge the staff nurse stated "the medical staff is responsible for completing the discharge sheet." S/he was unsure if an addendum was added to the computerized discharge instruction that was printed for Patient #4 to include the scheduled follow-up appointment.