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.

Based on staff interview, and review of medical records and hospital policies, it was determined the hospital failed to develop a system to identify patients who were likely to suffer adverse health consequences upon discharge if there was not adequate discharge planning. This failure affected 10 of 10 patients (#1 thru #10) whose records were reviewed for discharge risk screening. The lack of a system to identify patients with discharge planning needs at an early stage had the potential to delay discharge planning for all patients. Findings include:

The hospital's policy "Discharge Planning," effective 10/03/18, stated "Discharge planning screening will be initiated upon admission and continue throughout hospitalization . Case Management/Social Services will screen high risk patients within 24 hours of admission for appropriateness of admission and potential discharge planning needs." Additionally, it stated, "A comprehensive screening is performed to identify those patients who may have complex post-hospital care needs." The policy included a list of 16 items that would indicate a need for a discharge assessment, if identified during the screening. The policy did not state how information related to the 16 items would be obtained from each patient.

The 10 patient records reviewed did not include documentation of an initial discharge risk screening.

During an interview on 10/16/18 at 8:45 AM, the Director of Case Management stated that every patient admitted to the hospital received a discharge risk screening by an RN Case Manager. She stated the information reviewed by the RN Case Manager included admitting diagnosis, age, insurance, home address, and medical equipment used. It could not be determined how other criteria listed on the hospital's policy was determined, such as suspected abuse or neglect, financial concerns, multiple visits to the ED, multiple hospital admissions, or patients receiving home health or hospice services.

During an interview on 10/16/18 at 11:00 AM, an RN Case Manager described her discharge risk screening process. She stated each morning she printed and reviewed a report from the hospital's EMR. The report included the patient's name, diagnosis, address, and insurance information. She reviewed the report to determine which patients needed a discharge risk assessment. When asked how she would determine a patient had financial concerns, she stated lack of medical insurance would indicate financial concerns. The RN Case Manager stated she did not document the discharge risk screening.

During an interview on 10/17/18 at 10:05 AM, the Director of Case Management stated in the past the hospital's EMR had a program that pulled criteria that could affect patients' discharge needs from the SN assessment and triggered a case management consult. She stated there was a recent update to the EMR and she did not know if that had changed. The Director of Case Management confirmed the RN Case Managers did not have access to all of the criteria listed on the hospital's policy to determine the need for a discharge risk evaluation. Additionally, she stated the RN Case Managers had not been instructed to document discharge risk screening. She stated it would be very time consuming for the risk managers to document a screening for each patient.

The hospital failed to develop a system to ensure patients with discharge planning needs were identified at an early stage of hospitalization .

Based on review of medical records, and patient and staff interview, it was determined the hospital failed to ensure discharge planning needs for 1 of 5 patients (Patient #10) who were interviewed, were evaluated and re-evaluated on a timely basis to ensure the patient's needs were met. This prevented the hospital from identifying and addressing discharge needs in a timely manner. Findings include:

Patient #10 was a [AGE] year old female, who (MDS) dated [DATE], with complaints of numbness. She was admitted to the hospital, and diagnosed with [DIAGNOSES REDACTED].

An IDG meeting was observed on 10/16/18 beginning at 2:00 PM. During the meeting, the physician stated Patient #10 would be discharged the following day, and would continue her IV antibiotic therapy as an outpatient.

Patient #10 was interviewed on Tuesday, 10/16/18 beginning at 2:40 PM. She stated she was scheduled for discharge the following day. When asked how she felt about her discharge, she stated it "was not a good situation." Patient #10 stated she had no electricity at her home, lived alone, had no transportation, and was unable to take care of herself. When asked if she had talked to a social worker or case manager, she stated a case manager came to see her on Saturday, 10/13/18. Patient #10 stated she told the case manager she did not have electricity at her home. She stated she had no further contact with a social worker or case manager, and was concerned as she was scheduled to be discharged the next day with daily IV antibiotic treatments at the hospital.

Patient #10's record was reviewed with the Director of Advanced Clinicals on 10/16/18 at 3:15 PM. It included a case management note, dated 10/13/18, signed by an RN Case Manager. The note stated "Patient lives alone and states that she has not been able to take care of herself. States that she does not currently have electricity..." No additional case management note was documented.

The LSW responsible for Patient #10 on 10/16/18, was interviewed on Tuesday, 10/16/18 at 3:45 PM. She stated she was aware Patient #10 was to be discharged the following day, with orders for IV therapy as an outpatient. The LSW stated she had not seen Patient #10 because she was busy. She stated Patient #10 may have been seen by a case manager over the weekend, but she did not know who had seen her. The LSW stated she may have received an email from the weekend case manager regarding Patient #10, but she had been too busy to read the email. She confirmed no discharge planning evaluation was completed and no discharge plan had been initiated to address Patient #10's needs.

The hospital failed to ensure Patient #10 was evaluated for discharge risk in a timely manner, and failed to ensure a discharge plan was developed to prevent a potential for delayed discharge.