Covenant Hospital Levelland

“APPROPRIATE TRANSFER CFR(s): 489.24(e)(1)-(2) (1) General If an individual at a hospital has an emergency medical condition that has not been stabilized (as defined in paragraph (b) of this section), the hospital may not transfer the individual unless - (i) The transfer is an appropriate transfer (within the meaning of paragraph (e)(2) of this section); and (ii)(A) The individual (or a legally responsible person acting on the individual’s behalf) requests the transfer, after being informed of the hospital’s obligations under this section and of the risk of transfer. The request must be in writing and indicate the reasons for the request as well as indicate that he or she is aware of the risks and benefits of the transfer. (B) A physician (within the meaning of section 1861(r)(1) of the Act) has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual or, in the case of a woman in labor, to the woman or the unborn child, from being transferred. The certification must contain a summary of the risks and benefits upon which it is based; or (C) If a physician is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as determined by the hospital in its bylaws or rules and regulations) has signed a certification described in paragraph (e)(1)(ii)(B) of this section after a physician (as defined in section 1861(r)(1) of the Act) in consultation with the qualified medical person, agrees with the certification and subsequently countersigns the certification. The certification must contain a summary of the risks and benefits upon which it is based. (2) A transfer to another medical facility will be appropriate only in those cases in which - (i) The transferring hospital provides medical treatment within its capacity that minimizes the risks to the individual’s health and, in the case of a woman in labor, the health of the unborn child; (ii) The receiving facility (A) Has available space and qualified personnel for the treatment of the individual; and (B) Has agreed to accept transfer of the individual and to provide appropriate medical treatment. (iii) The transferring hospital sends to the receiving facility all medical records (or copies thereof) related to the emergency condition which the individual has presented that are available at the time of the transfer, including available history, records related to the individual’s emergency medical condition, observations of signs or symptoms, preliminary diagnosis, results of diagnostic studies or telephone reports of the studies, treatment provided, results of any tests and the informed written consent or certification (or copy thereof) required under paragraph (e)(1)(ii) of this section, and the name and address of any on-call physician (described in paragraph (g) of this section) who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment. Other records (e.g., test results not yet available or historical records not readily available from the hospital’s files) must be sent as soon as practicable after transfer; and (iv) The transfer is effected through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer. This Standard is not met as evidenced by: 47578 Based on observation, record review, and interview, the facility (Hospital A) failed to ensure all requirements of appropriate transfer were completed for two of 20 patients (Patient #1 and Patient # 10) who required inpatient psychiatric treatment. Hospital A failed to document patient consent to transfer, transmission of medical records to Hospital B, physician certification, reason for transfer, and accepting hospital information through use of a Memorandum of Transfer (MOT) form. The findings include: Record Review A review of the medical records indicated: Patient #1 presented to the Emergency Department (ED) for a suicidal attempt. The patient was provided with a psychiatric assessment and was transferred to a higher level of care due to Hospital A not having psychiatric services. The MOT form was not found in the patient record to support that a physician certification was completed, an accepting physician/hospital was obtained, patient consent was obtained, and medical records were sent to the receiving hospital. The medical record shows the patient was on an Emergency Detention Order (EDO) and was transported by police to the receiving facility. Patient #10 presented to the ED for suicidal ideations. The patient was provided with a psychiatric assessment and was transferred to a higher level of care due to Hospital A not having psychiatric services. The MOT form was not found in the patient record to support that a physician certification was completed, an accepting physician/hospital was obtained, patient consent was obtained, and medical records were sent to the receiving hospital. The medical record shows the patient was on an Emergency Detention Order (EDO) and was transported by police to the receiving facility. A review of facility policies indicated: EMTALA: Screening, Stabilization and Transfer of Individuals with Emergency Medical Conditions Policy, last reviewed, revised and effective 5/2021, indicated: An appropriate MSE should address the presenting symptoms and comply with current policies and procedures for assessment of those presenting symptoms, including but not limited to a history of the presenting problem; a documented physical examination of the involved area or system; and the use of on-call physicial examination of the involved area or system; and the use of on-call physicials and ancillary tests or services routinely available to the Hospital if needed to determine whether an EMC exists. Documentation should reflect monitoring until the patient is stabilized or transferred. Transfer of Unstable Patient: A transfer of an unstable patient with an EMC (eg. Uncontrollable bleeding; shortness of breath; potential symptoms of a heart attack, stroke, seizure, or drug overdose; severe digestive symptoms; other major trauma or burns, etc.) to another medical facility capabe of providing the patient with the necessary stabilizing treatment may be made in the following circumstances: “ Following the MSE, a patient may be transferred to another facility if the patient or their representative requests the transfer, after being notified of the hospital’s obligation and the risk of the transfer. “ The patient may be transferred to another facility if the hospital determines that it does not have the necessary medical and/or staffing resources to properly stabilize the patient, and one of the following occurs: o A physician has signed a certification that the medical benefits of the transfer are expected to outweigh the risks of transfer. The certification will state the reason for the transfer, patient condition/ benefit/risks of transfer, receiving hospital, mode of transportation, and patient consent. “ When a patient is transferred the consent of the receiving hospital to accept the transfer must first be obtained and documented in the medical record. The hospital shall send to the receiving facility, copies of all pertinent medical records available at the time of transfer, and affect the transfer through qualified personnel and transportation equipment. Transfer of Patient to Another Hospital Policy, last reviewed, revised and effective 8/2023, indicated: I. Policy “ A physician’s order is required for a patient transfer to another acute care facility that indicates a specific mode of transfer and any necessary hospiptal staff support. “ A “Memorandum of Transer,” a “Patient Request/Refusal/Consent to Transfer,” and a “Physician Certification for Transfer” will be completed and sent with all patients being transferred to any other acute hospital for Covenant Levelland. II. Medical Record The hospital will provide to the receiving physician and the receiving hospital, a copy of those portions of the patient’s medial record which are relevant to the transfer and the continuing care of the patient. At a minimum, this includes: 1. The patient’s medical history, physical exam or physical documentation 2. Reason for the transfer 3. Results of all diagnostic tests and pertinent x-ray films and reports. III. Procedure for Transfer 1. The Charge Nurse or designee will contact the receiving hospital/transfer center administrative person to verify that arrangements are being/have been made to accept the patient and the name of the receiving physician (if not already known from the patient’s attending physician). 2. The attending physician/ER physician will contact a physician at the receiving hospital or the transfer center to accept the patient. 3. A patient cannot be transferred until the receiving hospital agrees to accept the patient and a physician has agreed to care for the patient. 4. The names of the accepting physician and administrative person will be filled in on the “Memorandum of Transfer” in Section A by the Charge Nurse or designee that verified the agreements for transfer. a. It is the responsibility of the Charge Nurse or designee to complete and sign the Memorandum of Transfer, Section A, all blanks filled in. 5. The transferring unit will contact the transport entity based on information from the attending physician as to what support/specialized care the patient will require during transport and the physician’s order for transfer. 6. The nursing unit will notify the family or significant other that the patient is to be transferred to another hospital, will the approximate time to transfer, is available. 7. The original copy of the “Memorandum of Transfer,” “Physician Certification for Transfer” and “Patient Request/Refusal/Consent to Transfer” will accompany the patient to the receiving hospital. A copy of these documents will placed in the patient record. Interviews In an interview with Staff #2, Trauma Coordinator, on 6/18/2024, Staff #2 stated Patients #1 and Patient #10 were under police custody on an emergency detention order which could explain why the transfer requirements were not completed. In an interview with Staff #1, Chief Nursing Officer, on 6/19/2024 at 10 AM, Staff #1 acknowledged that the MOT forms were not located in the patient medical records therefore it could not be verified if the forms were completed and an appropriate transfer occurred. Staff #1 acknowledged that the policy indicates that all tranfer requiremets and an MOT form should be completed for all transfers regardless if the patients are in police custody. Staff #1 indicated that according to their ED process, the medical records would have been sent to the receiving hospital prior to transfer.”