Failure to Timely Obtain Orthopedic Consult Following Physician Order
Penalty
Summary
The facility failed to obtain an orthopedic consult as ordered by the physician for a resident who had suffered a left wrist fracture following a fall. After the fall, the resident was sent to the emergency room, diagnosed with a left wrist fracture, and returned to the facility with a splint and ace wrap. A physician order for an orthopedic follow-up was placed, but the consult was not arranged in a timely manner. Staff interviews and documentation revealed that the process for obtaining insurance authorization for the consult was not initiated until over a month after the order was written. The case manager, who was responsible for obtaining insurance authorization, was unaware of the order and was on medical leave during a critical period, with no clear delegation of responsibility in their absence. The delay in obtaining the orthopedic consult resulted in the resident not being evaluated by an orthopedic specialist until nearly two months after the initial injury and order. Staff interviews indicated confusion and lack of communication regarding who was responsible for securing insurance authorization and scheduling the appointment. The unit manager and transportation coordinator both cited insurance approval as a reason for the delay, but the necessary steps to obtain approval were not taken promptly. Facility documentation confirmed that the insurance authorization request was not made until several weeks after the order, and the resident's nurse practitioner acknowledged that the delay was not acceptable.