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.

ST JOSEPH MEDICAL CENTER 1401 ST. JOSEPH PARKWAY HOUSTON, TX 77002 June 18, 2014
VIOLATION: DISCHARGE PLAN Tag No: A0817
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on interview and record review hospital staff failed to have an effective Discharge Planning process that facilitates the provision of follow-up care in 1 of 19 emergency room records reviewed. (Patient ID# 1)

Findings include:

Record review of the emergency room record for Patient ID# 1 revealed she (MDS) dated [DATE] complaining of hurting everywhere. The Physician diagnosed the patient with Backache / Chronic Pain. The patient was discharged from the emergency room . The Discharge Instructions stated " Discharge Instructions: None. Prescriptions: None. Follow Up Instructions: Dr. ID# 58(Emergency Medicine) When: As needed: Reason: Change in condition. Special Notes: None Diagnosis: Chronic Back Pain. The follow up instructions listed Dr. ID# 58 in Durham, North Carolina and listed a North Carolina phone number. The follow-up instructions failed to address the patient ' s Back Pain. The Discharge Instructions were not signed by the patient.

The Risk Manager (ID# 66) acknowledged 6/20/14 at 10 a.m. that the Discharge Instructions failed to address Patient ID# 1's Back Pain. The Risk Manager further stated that the hospital had a computer glitch as to why a North Carolina address and phone number for a physician was provided to Patient ID# 1 on the discharge instructions. (St. Joseph Hospital is located in Houston, Texas)

Record review of a policy titled " Discharge From the Emergency Department: Discharge and Follow-up Instructions " dated 6/2014 stated:

" Policy: Each patient discharged from the Emergency Department will receive written discharge and follow-up instructions, as applicable.
C. Prior to discharge from the Emergency Department, each patient or his / her representative will be given complete instructions regarding any follow-up care he / she may require.
4. The patient or his / her representative will sign that he /she has received and understands the written discharge instructions with a copy given to the patient and a copy affixed to the medical record.
D. The physician is responsible for documenting the follow-up care that will be required. Patients are referred to their primary physician for continuing care EXCEPT for those that are instructed to return to the Emergency Department for specific follow-up care - i.e. for worsening of symptoms ..."

In summary, Patient ID# 1 was given a Discharge Instruction sheet upon discharge 6/7/14 with no clear instructions for chronic back pain. The patient was instructed to call a North Carolina phone number and listed an address in North Carolina to follow-up with the emergency room Physician.