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ERLANGER MEDICAL CENTER 975 E 3RD ST CHATTANOOGA, TN 37403 March 26, 2015
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on medical record review, facility policy review, and interview, the facility failed to appropriately transfer one patient (#24) of twelve patients reviewed for transfers.

The findings included:

Please refer to A-2409 for failure to complete an appropriate transfer form.
VIOLATION: APPROPRIATE TRANSFER Tag No: A2409
Based on medical record review, facility policy review, and interview, the facility failed to appropriately transfer one patient (#24) of twelve patients reviewed for transfers.

The findings included:

Patient #24 presented to the Emergency Department (ED) on February 19, 2015, at 1:09 AM, for a gunshot wound to the left upper arm and scratches to the upper chest and abdomen. Medical record review revealed Registered Nurse (RN) #1 triaged the patient at 1:17 AM as a level 3 (urgent) patient on the Emergency Severity Index (ESI).

Medical record review of a physician's note dated February 19, 2015, at 1:39 AM, revealed the patient had two ballistic (gunshot) wounds to the left anterior upper extremity. Continued review of a physician's note at 2:11 AM revealed "...after talking with police there was no one at the house...husband has no real history of attempt to kill pt [patient]...pt has had a history of Suicide attempt but when asked pt denies history...per police they have been called out two time[s] once for overdose and second time attempt hanging..." Further review of a physician's note at 2:24 AM revealed "...story does not fit with her history of events...has wound consistent with self harm will fill out CON [certificate of need] and have CRT [crisis response team] eval [evaluate] for placement..."

Medical record review of a nurse's note dated February 19, 2015, at 12:36 PM, revealed Patient #24 was accepted at a psychiatric facility and report was called to the accepting facility. Further review revealed the patient's medical record and diagnostic studies were copied for the receiving facility.

Medical record review revealed no documentation of a transfer form or physician certification of need for transfer for Patient #24.

Review of facility policy, "EMTALA-Transfer Policy," not dated, revealed "...may transfer the individual only if...a physician has signed a certification...certificate must contain a written summary of the risks and benefits...must state reason for transfer...date and time...must match the date and time of the transfer...if a physician is not physically present at the time of the transfer, a QMP [qualified medical person] may sign the certification after consultation with a physician..."

Interview with RN #2 on March 24, 2015, at 10:40 AM, in the assistant nurse manager's office, revealed "...don't remember seeing a transfer form..."

Telephone interview with RN #1 on March 24, 2015, at 1:10 PM, revealed "...don't remember transfer forms..."
Telephone interview with RN #3 on March 24, 2015, at 7:47 PM, revealed "... I don't remember seeing a transfer form..."

Interview with the Corporate Preparedness Officer, on March 24, 2015, at 1:30 PM, in the conference room, confirmed the facility failed to complete a transfer form for Patient #24.