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.

VIRGINIA HOSPITAL CENTER 1701 NORTH GEORGE MASON DRIVE ARLINGTON, VA 22205 Oct. 25, 2017
VIOLATION: IMPLEMENTATION OF A DISCHARGE PLAN Tag No: A0820
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on staff interview, clinical record review, and facility document review, the facility staff failed to ensure the facility prepared the family, per their request and permission granted by the patient, for post-hospital care for one (1) of three (3) patient records reviewed for discharge planning.

The findings included:

Patient #4 was discharged from the in-patient treatment setting to another facility providing continuing stabilizing care; however, the patient's family was not provided information regarding the type of facility the patient was being transferred to, what the family responsibilities would be in regards to that transfer and treatment, and the opportunity to participate in a care planning meeting. The meeting was scheduled, however the patient was discharged prior to the date, and the family was not notified so that they could have their concerns and questions answered prior to the patient's discharge.

Patient #4 was admitted to the facility on [DATE] with diagnoses related to behavioral health. The patient was discharged from the facility to another level of care on 11/2/16.

Contained in the clinical record was a document titled, "Behavioral Medicine Department Consent for Release of Confidential Information" dated 10/16/16 and signed by Patient #4. This document evidenced the patient authorized the facility to disclose to [names of two family members] "presence and progress in Tx (treatment) and discharge for the following purpose(s) Continuity of Care"...

On 10/24/17 at 2:00 p.m., Staff Member #13 (Case Manager) informed the surveyors that Patient #4 signed the ROI giving facility staff permission to talk to family. "If the patient stated that they no longer wanted us to talk to them, then we would not. I left a message with [family] on October 18th, and spoke with [family] on the 25th. I also spoke with [family] on November 1st about the patient going to [facility] and the patient's progress...there are physician's notes of discussions with [family] as well..."

Also contained in the clinical record was an "Interdisciplinary (ID) Recovery Plan" dated 10/13/16 and 10/14/16, signed by members of the ID team and Patient #4. In the section "Discharge and Continuity of Care" was the following:
(This was a hand-written document)
*MD to call family meeting
1. Signed ROI (release of information) for family
2. D/C (discharge) later this week- assess for D/C next week [DATE]nd/3rd
3. Consider crisis care or [name of facility]
4. Family meeting 10/19- arrange 2nd family meeting Thurs/Fri (no date on document)
5. Refer to [name] or Crisis Care D/C Wed or Thursday (no date on document)

The surveyor interviewed Staff Member #2, on 10/24/17 at 2:00 p.m., regarding the second family meeting. "The meeting was supposed to be on Wednesday or Thursday (11/2/16 or 11/3/16), but the bed became available for [name of facility] and the patient was discharged before the meeting could take place...If you look at the physicians notes and in the clinical record, there were multiple conversations with the [family]. There were times when the patient would not allow the physician or staff to contact [family] and even though [patient] signed the ROI, it can be revoked at any time. The patients have rights to their privacy and to whom information is shared. We have to honor the patient's rights..."

The survey team discussed with the facility (Staff Members #1, #2, #6, #9, #13, and #14), on 10/24/17 at 2:10 p.m. and on 10/25/17 at 10:00 a.m., the discharge planning for Patient #4, and inquired as to the type of facility the patient was discharged . On 10/24/17 the surveyors were informed Patient #4 had been discharged to was a "crisis stabilization unit", which was described as a "step down" from inpatient hospitalization . Staff Member #13 stated, "It is a two-week program which focuses on mental health. It is overseen by a Psychiatrist and Nurse Practitioner. Patients have to participate in six group therapies a day. The staff make sure the patients get their medications, and we provide two weeks of medications for the patient while they are there...I am not sure if they are seen daily by the psychiatrist...this facility is approved by [insurance company] and if the patient has this insurance, which [patient] did, then they [insurance company] has psychiatrist, social worker and therapies already lined up. If they are a new patient, then we connect them with the CSB (Community Services Board) and they are allowed a pass to go to appointments, but a family member can take then, but there is a staff vehicle which can be used if the patient doesn't have anyone to assist them. After the two weeks, they have to get their medications through their case manager or appointment with the psychiatrist they are seeing. While they are there they have medication management and adjustments by the Nurse Practitioner or Psychiatrist."

On 10/25/17 at 8:00 a.m., the following information was provided to the surveyor by Staff Member #14. "The facility is under the umbrella of [company] and the house that the patients go to is called [name]. It is a residential house, usually the patients stay two weeks. It is not long term. It is a step down from inpatient hospitalization , and a diversion from jail or crisis in the community. It is for people who do not meet inpatient criteria but need stabilization. There is a nurse on duty at all times and supportive staff. Meals are provided, and patients are provided showers and must attend six groups a day. The Nurse Practitioner and Psychiatrist oversees the program and come two times a week. During the time the patient is there they work on discharge to the community.

Further documentation in the clinical record revealed a "Discharge Medication List". This document contained a list of the medications Patient #4 was prescribed at discharge.

Another document "Patient's Discharge Information Provided to Next Level of Care" was contained in the clinical record and evidenced the following: "The following Required Continuing Care Plan Discharge Documents: Psychiatric Admission and History, Physician Discharge Progress Notes, Nursing Discharge Documentation, Medical History and Physical, Discharge Instructions, Discharge Medication Reconciliation Form (including drug name, dose, indicator for each medication, and next dose due) were transmitted to "other" . Transmission completed by: (Name of Registered Nurse) date 11/2/16 at 7:30 p.m."

On 10/24/17 at 2:00 p.m., Staff Member # 2 stated, "All these documents are faxed to the receiving facility upon discharge".

The surveyor was unable to locate, in the clinical record, information that the family of Patient #4 was notified on the day the patient was discharged , prior to the patient leaving the hospital, nor provided with a copy of any discharge instructions as were given to the patient, as well as what type of facility the patient was discharging to and information on the facility (treatment, programs, etc.) that would be of benefit to the family.

There was also documentation that a family meeting had been planned prior to discharge, however the patient was discharged from the facility before the date of the planned meeting, without documentation of prior notification of the family that this was going to occur, which would have allowed the patient's family to receive further information on the discharge and the ability to have questions answered prior to the Patient leaving the facility.

The concerns were discussed with the facility Administration, Staff Members #1, #2, #4, #5, and #14 on 10/25/17 at 12:00 p.m.