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STRONG MEMORIAL HOSPITAL 601 ELMWOOD AVE ROCHESTER, NY 14642 Sept. 28, 2018
VIOLATION: INTEGRATION OF EMERGENCY SERVICES Tag No: A1103
Based on medical record review, document review and interview the facility did not ensure a safe mode of transportation home on discharge from the Emergency Department (ED) for 1 of 3 discharged patients. (Patient #3)

Findings include:

Review of policy # 76, Patient Discharge Guidelines, last reviewed 12/01/16 revealed each patient being discharged from the Emergency Department is to be reviewed for discharge needs. The facility will provide appropriate collateral referrals (e.g. home health care), resources (e.g. clothing shelter), and transportation in support of safe patient discharge. The patient's access to his or her residence has been confirmed. Appropriate transportation has been confirmed or arranged, with social work assisting as needed. Chair mobile transportation is used for patients whose medical condition requires it, if the patient is noted to be frail, or if the treatment team feels the patient is in need of escorted travel from the ED to the inside of his/her residence.

Review of Patient #3's ED medical record dated 9/5/18 revealed the patient was an elderly female with a history of dementia and multiple medical problems who was sent to the ED from a dialysis center with complaints of neck pain. Despite a discrepancy with addresses, the patient was ultimately discharged via taxi cab on 09/06/18 at 05:00am. Although the patient's daughter and husband had visited the patient earlier, there was no evidence to indicate they were notified of the discharge.

Interview on 09/26/18 at 07:00 AM with Staff (K), Social Worker revealed that on 09/06/18, ED staff requested a hospital funded cab voucher. Although Staff (K) was aware that the patient's address documented in the chart and the address the patient provided were different, this information was not explored further. Staff (K) was confident the patient was alert and oriented, was able to access her home independently and she did not express a desire for her family to be notified prior to discharge. She was confident there were no safety concerns sending the patient home via taxi without an escort to her door.

Interview on 09/26/18 at 10:00 AM with ED Managerial staff (A, E, I, J, Z) revealed the facility's internal investigation identified that taxi drivers do not escort patients to their front door and Wheelchair Mobile and Stretcher Mobile do provide patient escort to their front door. It was noted that the Medicaid cab lines were closed for the day and the Social Worker was requested to provide a voucher for taxi services to the address listed in the patient's medical record. Although the Social Worker acknowledged the address in the chart was not the same as the address the patient provided, the Social Worker SW did not investigate the discrepancy. It was noted that because the patient was elderly, and it was early in the morning, the patient should have been provided with a medical transport (Medicab) that would have escorted the patient to their front door.

Interview on 09/28/18 at 01:30 PM with Staff (E) confirmed the above findings.