Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 670068 (X3) Date Survey Completed 03/18/2014
Name of Provider or Supplier Texas Health Presbyterian Hospital Flower Mound Street Address, City, State 4400 Long Prairie Road, Flower Mound, TX
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
A0837 TRANSFER OR REFERRAL
CFR(s): 482.43(d)

The hospital must transfer or refer patients, along with necessary medical information, to appropriate facilities, agencies, or outpatient services, as needed, for follow-up or ancillary care.


This STANDARD is not met as evidenced by:
Based on interviews and record reviews, Hospital A failed to ensure 1 of 10 patients (Patient #1's) necessary medical record information was provided to Hospital B which addressed (Patient #1's) altered skin integrity which was identified on admission to Hospital A on 07/15/13. Findings Included: Hospital A: (Patient #1's) ED (emergency department) physician note dated 07/15/13 timed at 20:37 PM, reflected, "Tiny skin split...sacrum..." The 07/17/13 decubitus body picture timed at 17:45 PM, reflected, "Redness coccyx..." The 07/23/13 decubitus body picture timed at 07:35 AM, reflected, "Whole sore unstageable, blanchable reddened bottom..." The physician orders dated 07/23/13 timed at 08:45 AM, reflected, "Discharge to rehabilitation today...follow-up with primary care physician one week after rehabilitation discharge..." No documentation was found which indicated Hospital B was informed regarding (Patient #1's) altered skin integrity. On 03/14/13 at 01:00 PM, Personnel #1 was interviewed. Personnel #1 said she could not find any documentation in the case management notes and transfer documentation which indicated Hospital B (Patient #1) was transferred to was informed (Patient #1) had altered skin integrity. The Medical Staff Rules and Regulation with an approval date of 04/17/13 reflected, "The discharge summary shall concisely include...final diagnosis, evaluated and treated during encounter...hospital course...medical care, treatment and services provided and how patient responded to care, treatment...provisions for follow-up care...complications and all other treated diagnosis and procedures shall be recorded in full...additional diagnosis must also be recorded which may exist prior to the admission of the patient or develop after the patient's admission..."