HospitalInspections.org

Based on interview, record review, video review and a review of facility documentation, the facility failed to ensure that personnel who complied with facility policy for outpatient admission were available to presenting patients where outpatient services are offered for 1 of 21 sample patients (#21).

Findings:

An interview was performed with the Patient Liaison of the Outpatient Registration department at 10:33 AM on 3/13/17. During the interview, she stated that when a patient arrives in her area and presents a prescription, she checks to see if it is valid. She stated that when she checks a prescription, she looks for the following: the presence of a full name; an order date that is not more than six months old; the name of the procedure or test; the diagnosis; the presence of wording such as "rule out" or "history of" (which they cannot accept); and the presence of a practitioner signature (no stamp pad signatures). She stated that she may also ask what type of insurance would be used. She stated that if everything is in order, she would place the patient on the computer "tracker" and indicate whether or not the patient was a walk-in or an appointment. After this, the patient would be asked to have a seat and await a call by the patient Registrar. During the interview, the Patient Liaison was asked if she recalled any recent presentations by a pregnant woman in which there was some confusion or discrepancy regarding orders they might have put forth. She indicated that a patient of Dr. A, patient #21, had presented with an order for lab work on 3/08/17. She stated that after learning the name of the patient's insurance provider, she told the woman that they could not accept her insurance. She then told her that she could go to the nearby Quest or LabCorp to get the labs drawn. She stated that since the patient could not be accepted for lab work, she was not entered into the computer. She stated that the patient then left the facility.

The facility produced a copy of an e-mail which was sent by the Patient Liaison to the Director of Patient Access and the Manager of Patient Access on 3/10/17. It read: "I had three expectant mothers come to my desk on the same day (3/08/17)....I do not remember names, it was very busy, however I do remember it was a (Dr. A) patient with... insurance....the patient told me she was here for labs, and to my knowledge, the paperwork given to me was for labs. I also asked (patient registration staff member) or (patient registration staff member) could we accept orders for labs, not NSTs (non-stress test). I did so because I wanted confirmation with someone who handles insurance more than me because of the daily charges that occur with insurances."

Regarding the statement in the e-mail of the paperwork not having an order for a NST, an interview with the Manager of Patient Access was performed on 3/13/17 at 12:01 PM. At this time, the name of the patient to which they were referring was patient #21. She stated that the office manager of this patient's physician had called her in the afternoon of 3/08/17 and inquired about what happened when the patient presented to the hospital. The Manager of Patient Access stated that the office manager told her that the patient had been given two prescriptions, one for labs and one for a NST. The Manager for Patient Access stated in the Patient Liaison's e-mail that only a prescription for labs was presented by the patient.

The text of the above mentioned e-mail continued with further clarification of the previously quoted e-mail text which mentioned "NST". It read, "I did not see NST on the order. I also am aware that NSTs can go to L&D (Labor & Delivery). I am not sure how I could have missed that, as I see them often....I gave her a printout with LabCorp, and Quest on it so she could be seen that day...."

An observation of security camera footage which covered the Outpatient Registration desk was performed on 3/13/17 at approximately 1:22 PM. The video revealed the presentation of the woman as described (and confirmed) by the Patient Liaison at approximately 1:55 PM on 3/13/17. The video showed the following for 3/08/17: the patient walked in at 2:38 PM, interacted with the Patient Liaison at 2:40 PM, and handed a paper to the Patient Liaison at 2:40 PM. Between this time and patient #21's departure, the Patient Liaison was seen moving various papers around and using the telephone. At 2:44 PM, the Patient Liaison gives the woman a paper. At 2:45 PM, she gives the woman another paper, and then the woman goes out the door. At 1:55 PM on 3/13/17, the Patient Liaison stated she could not recall why there was movement of papers.

On 3/13/17 at 2:10 PM, the Manager of Patient Access said during the course of this survey, the physician's office had sent over copies of the prescriptions which had been sent with patient #21. One prescription read, "24 urine protein collection. Dx: swelling in extremities" and the other read, "CBC (complete blood count), CMP (Comprehensive Metabolic Panel), Uric Acid, BPP (Biophysical Profile), Lipase. Dx (diagnosis): Biliary colic. Swelling in extremities."

On 3/13/17 at 3:14 PM, the Director of Patient Access stated it was the job of the registrar to make inquiries as to the patient's insurance status, to determine what would be covered. A review of the Registrar's job description read, "Verify all insurance and obtain pre-certification/authorization." On 3/14/17 at 11:41 PM, the Director of Patient Access stated this means the Registrar checks the patient's insurance to see if orders for tests and lab work would be covered. There was no evidence that Patient Liaison had mentioned a non-lab Biophysical Profile test which was also on the prescription. As a result, the patient was not afforded a review of her prescriptions by designated employees who would have seen that more than labs were actually involved, the Biophysical Profile, and subsequently pursue at least this aspect of the physician's desired evaluation of the patient.

On 3/14/17 at 11:18 AM, the Risk Manager stated when patient #21 was at the hospital, the Patient Liaison called one of the Registrars to seek clarification regarding insurance for labs. The telephone call inquiry by the Patient Liaison dealt solely with labs, not any diagnostic testing.

On 3/14/17 at 2 PM, the Risk Manager stated that if the Registrar had evaluated the prescription for the Biophysical Profile, the facility would not have pursued the implementation of this test for the patient, due to the incompatible insurance. Instead, the patient would have been told of the non-coverage and tell her where the test could be performed with her insurance. The patient would also have been told of the option to self-pay in the facility. Since none of this occurred, the patient was deprived of the ability to pursue a diagnostic evaluation.

During an interview of the Risk Manager at approximately 3:30 PM on 3/14/17, she confirmed the findings.