HospitalInspections.org

Based upon review of Medical Staff Rules & (and) Regulations, medical record review, and administrative staff interview, the facility failed to ensure physician ordered specialty consults were performed within 48 hours of physician order in 3 of 3 patients (Patients # 4, 11, and 12).
The findings include:
Review of Medical Staff Rules & Regulations, Revision 2010, revealed, "...The Medical Staff Rules and Regulations are adopted for the purpose of implementing more specifically the general principles found within the Medical Staff Bylaws of the Hospital. The Rules and Regulations are a component part of the Medical Staff Bylaws... 1.1 Admission, Treatment, and Discharge of Patients... L. Consultations should be completed within 48 (forty-eight) hours..."
1. Review of a physician order, written by MD (Medical Doctor) #1 on 11/23/2016 at 14:31 for Patient #4, revealed, "Consult (Named Neurologist #1) re (reference): TBI (Traumatic Brain Injury). Consult (Named Neurologist #2) re: TBI, Hx (History) of SDH (Subdural Hemorrhage) and SAH (Subarachnoid Hemorrhage)..." Review of Patient #4's open medical record on 11/30/2016, approximately 168 (one hundred and sixty eight hours later), revealed no neurological consult had been performed. Review of a physician order, written by MD #2 on 11/30/2016, no time provided, revealed, "D/C (Discontinue) consult written on 11/23/2016, (stricken through with a line, followed by "ERROR" with 11/30/16 written above), For TBI. Consult non-emergent. Reconsult (Named Neurologist #2) on 12/9/16 for TBI."
Interview with Administrative Staff #1 conducted on 11/30/2016 at 15:00, revealed the ordered consult was not performed within 48 hours.
2. Review of a physician order, written by MD #1 on 11/07/2016 at 12:00 for Patient #11, revealed, "PEG (Percutaneous Endoscopic Gastrostomy) Consult." Review revealed the consult was performed on 11/10/2016 at 18:10 (78 hours, and 10 minutes), by MD #3.
Interview with Administrative Staff #1 conducted on 12/01/2016 at 10:00, revealed the ordered consult was not performed within 48 hours.
3. Review of a physician order, written by MD #4 on 11/05/2016 at 18:00 for Patient #12, revealed, "...Consult (Named Podiatrist #1)..." Review revealed a consult was performed by Podiatrist #1 on 11/10/2016 at 13:52 (116 hours and 52 minutes later).
Interview with Administrative Staff #1 conducted on 12/01/2016 at 10:00, revealed the ordered consult was not performed within 48 hours.
NC00121305