05/26/2022

Survey Tip of the Week: Hospitalization

The Long-Term Care Survey Process (LTCSP) instructs surveyors to review a closed record of a hospitalized resident to determine if facility practices are in place to identify and assess a change in condition, intervene as appropriate to prevent hospitalizations, and evaluate compliance with requirements surrounding transfer and discharge. Surveyors will identify any resident marked as non-interviewable, refused, unavailable, or out of facility to select the closed record to review for a resident who was hospitalized in the last 120 days. A surveyor may select a resident with a confirmed case of COVID-19 in the last four weeks who was hospitalized or died (the information would be provided by the facility on the first day of survey). The record will be looked at to identify if the facility adequately identified and addressed the resident’s change in condition and if changes in the resident’s status or other risks associated with the hospitalization were identified as soon as possible. The record will also be reviewed for the required transfer and bed hold notifications.

If the resident has returned to the facility, the surveyors will observe the resident to identify if they are exhibiting the same symptoms that sent the resident to the hospital. The surveyor will observe the resident for physical distress, mental status changes, change in condition, and pain. The resident representative may be interviewed to determine proper notification. Staff interviews may include the following questions:

• When did the hospitalization occur? What was the cause (e.g., pain, infection, mental status change, or fall)?
• Do you have a structured process for identifying and addressing a resident’s change in condition (e.g., facility developed tool, Interventions to Reduce Acute Care Transfers [INTERACT])?
• Prior to the hospitalization, did the resident have a change or decline in condition? If so, when? How often did you assess the resident? Where is it documented?
• If the resident had a change in condition, who did you notify (e.g., practitioner or representative) and when?
• Prior to or after the hospitalization, did the resident refuse any treatment? What do you do if the resident refuses?
• Is the resident at risk for additional hospitalizations?
• Since the resident returned from the hospital, has the resident had a change or decline in condition? If so, what interventions are in place to address the problem(s)?
• How do you monitor staff to ensure they are implementing care-planned interventions?
• How did you involve the resident/representative in decisions regarding treatments?
• If care plan concerns are noted, interview staff responsible for care planning about the rationale for the current care plan.

Additional surveyor guidance on the close record review, observations, and interviews can be found in the LTC Hospitalization Critical Element Pathway. LeadingAge Ohio encourages facilities to utilize the LTC Survey Pathways to monitor for compliance. The survey pathways can be found on the CMS Nursing Home webpage, under the download section, and within the zip file called LTC Survey Pathways.

For more information about the citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the June 8 call at 10:00am which will focus on adverse events.

LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you’d like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.