Based on clinical record reviews, review of facility policies and procedures and interviews with facility personnel for 2 of 10 sampled patients (Patient #1 and Patient #3), the facility failed to provide emergency psychiatric services upon dispatch by Emergency Medical Services to be transported to the hospital. The findings include: 1. Patient #1 had complaints of texting suicidal expressions to a significant other. Review of the ambulance run sheet dated 2/7/16 identified that Patient #1 denied the desire to harm self. EMS #1 dispatched Hospital #1 to transport the patient to the emergency department (ED). EMS #1 was diverted to Hospital #2 by MD #2, who requested the patient be sent to another hospital for psychiatric services. Hospital #2 was an additional 45 minutes away. Interview with MD #2 on 3/24/16 identified that he had diverted the patient to Hospital #2 due to the fact it was a Sunday afternoon and the patient would have to wait overnight to be seen by a psychiatrist the next morning. Review of the clinical record from Hospital #2 dated 2/7/16 identified that Patient #1 was evaluated by crisis and was sent home with outpatient services. 2. Patient #3 had complaints of suicidal thoughts. Review of the ambulance run sheet dated 12/27/15 identified that EMS #3 dispatched Hospital #1 for admission since Patient #3 had an Emergency Committal for an evaluation. MD #2 initially accepted the patient, then called back reporting they do not have the appropriate resources available. At that time, MD#2 requested that Patient #3 be transported to Hospital #2 (45 minutes away). Review of clinical record from Hospital #2 dated 12/27/15, identified that Patient #2 was evaluated by crisis and discharged on [DATE] with a disposition of depression/anxiety. Patient #3 was to follow-up with outpatient psychiatric services and VNA services. Review of hospital policies identified that the hospital social worker and/or psychiatrist should be consulted on all patients to assist with a clinical assessment and disposition. Interview with MD #2 on 3/24/16 identified that patients who present to the ED on the weekend would have to wait until Monday to see a psychiatrist and/or social worker if they have specific psychiatric needs. Interview with LCSW #1 on 3/24/16 identified that her hours are Monday- Friday. In addition, there is an on-call list for case management on the weekend, however, she is the only person qualified to do crisis management. Further interview with LCSW#1 identified that she has not come in on a Sunday to provide crisis intervention services in over one year. Interview with MD #3 (psychiatrist) on 3/30/16 identified that he/she provides psychiatric services to the senior Behavior Health Unit, however, as a favor, he/she and his staff will provide psychiatric evaluations to patients who present to the ED during regular work hours. In addition, MD #3 was not aware that the hospital had a crisis social worker. MD #3 also indicated that on the weekend, he is available either day and/or by phone, otherwise the patient would need to wait until the following morning for a psychiatric evaluation.

Based on clinical record reviews, review of hospital policies and procedures and interviews with facility personnel, the hospital failed to ensure that crisis intervention services were available when a patient presents to the Emergency Department (ED). The finding includes: Review of provider coverage schedule for psychiatric services dated 3/23/16 identified that ED consultations would be completed by the provider on site for that day, however, the schedule failed to indicate the timeframe of provider coverage. Review of provider coverage schedule dated 3/30/16 identified that the provider would provide coverage for ED consultations, while onsite from 9:00 AM-11:00 AM Saturday and/or Sunday. In addition, review of the Social Worker schedule dated 3/30/16 identified that coverage for crisis coverage on weekend was one Saturday a month and a rotation schedule of shifts and Sunday, one week a month. Interview with LCSW #1 on 3/30/16 identified that he/she does not usually come in on a Sunday. Review of hospital policies identified that the hospital social worker and/or psychiatrist should be consulted on all patients to assist with a clinical assessment and disposition. Interview with MD #2 (ED) 3/24/16 identified that patients who present to the ED on the weekend would have to wait until Monday to see a psychiatrist and/or crisis worker for specific psychiatric needs. Interview with LCSW #1 on 3/24/16 identified that her hours are Monday- Friday. In addition, there is an on-call list for case management on the weekend, however, he is the only person qualified to do crisis management. Interview with LCSW #1 on 3/30/16 identified that he/she does not usually come in on a Sunday and has not come in on a Sunday to provide crisis intervention services, in over one year. Interview with MD #3 (psychiatrist) on 3/30/16 identified that he/she provides psychiatric services to the senior Behavior Health Unit, however, as a favor, he/she and his staff will provide psychiatric evaluations to patients who present to the ED during regular work hours. In addition, MD #3 was not aware that the hospital has a crisis social worker. MD #3 also indicated that on the weekend, he is available either day and/or by phone, otherwise the patient would need to wait until the following morning for a psychiatric evaluation.