HospitalInspections.org

Based on record reviews and interviews, the hospital failed to implement an appropriate discharge for 1 (#5) of 5 (#1-#5) discharged patients sampled. This deficient practice is evidenced by the hospital knowingly discharging Patient #5 to a homeless shelter that was closed. This deficient practice had the potential to affect any patient who was discharged from the facility to a homeless shelter.
Findings:

Review of the policy and procedure titled, "Discharge Planning" revealed, in part, 2.The patient, and with their consent, the patient's family, significant others, and outside support systems will be incorporated into the discharge planning process.

Review of the policy and procedure titled, "Scope of Services", revealed, in part, 4. Referral for aftercare services to continue the process of recovery. The procedure read, in part, Social Services: discharge planning; patient transfer, referral and placement; and aftercare coordination.

Review of the policy and procedure titled, "Discharge Criteria/Discharge Planning Standards" revealed, in part, it is the policy of the hospital to define discharge planning standards and to consider factors which may influence the success or failure of the discharge plan. The assessment of patients included, 1.f. Patient is returning to stable living situation. If the patient is not returning home, the eligible appropriate alternatives have been actively evaluated by the interdisciplinary team. 5. The coordination and implementation of the discharge plan, including appropriate referrals, is the responsibility of the social work staff.

Review of the policy and procedure titled, "Social Work Plan and Services" read, in part, the goal 3. To ensure that treatment and discharge planning takes into account the patient's family and community resources; 13. The social services staff will be the Hospital's designated discharge planning coordinator.

Review of Patient #5's medical record revealed he was legally committed to the hospital via a Coroner's Emergency Certificate (CEC) on 06/16/2022 at 1:25 p.m. and a Physician's Emergency Certificate (PEC) on o6/16/2022 at 2:15 p.m. Further review revealed Patient #5 was discharged on 06/23/2022 at 9:00 a.m.

Review of Patient #5's Psychiatric Evaluation revealed diagnoses, in part, Axis I - Mood Disorder, not otherwise specified, Rule out Bipolar disorder, Methamphetamine abuse, and rule out substance induced mood disorder; Axis V - Global Assessment of Functioning - 20.

Review of Patient #5's social services progress notes dated 06/22/2022 at 2:30 p.m. revealed, in part, Patient #5 refused rehabilitation services and would be discharged to a homeless shelter. Further review revealed the facility failed to attempt placement elsewhere or delay the discharge since they had knowledge that the homeless shelter was closed.

Review of the Continuing Care/Discharge Plan form dated and signed by S2SW on 06/23/2022 at 6:00 a.m. failed to document the change in the discharge plan disposition since Patient #5 was being discharged to a homeless shelter that was closed.

In interview on 07/25/2022 at 1:14 p.m., S1RN indicated the hospital ensured patients were discharged to a physical address. S1RN further indicated hospital staff had prior knowledge that the homeless shelter where Patient #5 was discharged to had been closed for months.

In interview on 07/26/2022 at 11:15 a.m., S4SW indicated she was assigned to Patient #5 and acknowledged the homeless shelter he had been discharged to had been closed. S4SW further indicated since the beginning of the survey, the social service department began the process of changing the discharge policy to have patients discharged to family members with a list of resources because "clearly sending them to a closed shelter is not a safe discharge".