HospitalInspections.org

Based on tour of the Emergency Department (ED) and staff interviews it revealed the facility failed to ensure patients were afforded the right to confidentiality when presenting to the ED for care (see Tag 143).

Based on a tour of the facility, document review and staff interview it was revealed patients do not have the right to confidentiality when the medical screening exam (MSE) is initiated while the patient is assessed by the physician sitting in the emergency department (ED) waiting room. This failure has the potential to adversely affect all patients due to patient's personal information being overheard by other patients in the ED waiting room.

Findings include:

1. A tour of the ED was conducted on 10/4/21 at 9:54 a.m. During the tour of the ED waiting room, while I was standing in the hallway in front of the ED waiting room, a medical staff member came into the ED waiting room and began assessing a patient. Talking could be overheard between the medical staff and the patient. Other patients were sitting in the waiting room across from the physician assessing the patient.

2. An interview was conducted with medical staff #1 on 10/5/21 at 2:24 p.m. When asked about initiating the MSE while a patient is waiting in the ED waiting room, medical staff #1 stated that it is done daily. Medical staff #1 stated they are trying to get the process going so patients are not waiting for hours. When I explained about confidentiality, medical staff #1 stated, "I will go back to how it was, and patients will just have to wait eight (8) to nine (9) hours."

3. A review of the policy titled "Patient Rights and Responsibilities dated 03/2021 stated in part: "The Patient/Parent/Guardian/Patient Representative, (when appropriate), is entitled to: Expect that all communication and records pertaining to your care is treated as confidential by the hospital, etc..."

4. An interview was conducted with the Medical Director of the ED on 10/5/21 at 2:46 p.m. When asked about initiating the MSE while patients remain in the waiting room of the ED, the medical director stated, "There is not much privacy in the ED. There are curtains between the beds in the ED, this is not any different. Privacy is not always possible." I explained a complaint was received concerning the MSE occurring in the waiting room of the ED. The medical director stated there is a room for the physicians to use while the patients are in the waiting room of the ED, a triage room if available. I explained the triage room was available during the tour of the ED waiting room, and I witnessed a MSE being initiated while the patient was in the waiting room. The medical director stated, "I agree with the triage room being used to initiate the MSE." The medical director concurred the MSE should not be initiated in the ED waiting room when other patients are in the waiting room.

Based on a tour of the emergency department (ED), observations and staff interview it was revealed the facility failed to ensure nursing staff follow accepted standards of practice to prevent the transmission of infections and communicable diseases. This failure has the potential to adversely affect all patients who present to the ED.

Findings include:

1. A tour of the ED was conducted on 10/5/21 at 9:54 a.m. The Director of Quality, Director of the ED, and the Assistant Chief Nursing Officer (ACNO) accompanied the surveyor on the tour. During the tour of the clean supply room, one (1) urinal was on the floor in the clean supply room. When the Director of the ED was asked about the urinal, the Director of the ED picked up the urinal off the floor and put it back in with the clean supplies for patient use.

2. An interview was conducted with the Director of the ED and the ACNO after the completion of the tour of the ED. When asked about clean supplies lying on the floor of the clean supply room being put back in the supply bin for patient use, the ACNO stated these supplies should not be put back in clean supplies for patient use. The ACNO concurred any supplies on the floor of the clean supply room is contaminated and contaminates the supplies if it is put back in the supply bin.

A. Based on document review and staff interview it was revealed the facility failed to ensure all medical staff followed the medical staff bylaws and hospital policies concerning confidentiality and patient rights. Patients do not have the right to confidentiality when the medical screening exam (MSE) is initiated when the patient is assessed by the physician while sitting in the emergency department (ED) waiting room. This failure has the potential to adversely affect all patients due to patient's personal information being overheard by other patients in the ED waiting room.

Findings include:

1. A tour of the ED was conducted on 10/4/21 at 9:54 a.m. During the tour of the ED waiting room, while I was standing in the hallway in front of the ED waiting room, a medical staff member came into the ED waiting room and began assessing a patient. Talking could be overheard between the medical staff and the patient. Other patients were sitting in the waiting room across from the physician assessing the patient.

2. An interview was conducted with medical staff #1 on 10/5/21 at 2:24 p.m. When asked about initiating the MSE while a patient is waiting in the ED waiting room, medical staff #1 stated that it is done daily. Medical staff #1 stated they are trying to get the process going so patients are not waiting for hours. When I explained about confidentiality, medical staff #1 stated, "I will go back to how it was, and patients will just have to wait eight (8) to nine (9) hours."

3. A review of the medical staff bylaws titled "Medical Staff By-Laws, dated 2021 stated in part: Each AHP (Allied Health Provider) shall: Provide his/her patients with continuous care at the generally recognized professional level of quality; Abide by the Medical Staff Bylaws and other lawful standards, policies and Rules and Regulations of the Medical Staff, and personnel policies of the Hospital."

4. A review of the policy titled "Patient Rights and Responsibilities dated 03/2021 stated in part: "The Patient/Parent/Guardian/Patient Representative, (when appropriate), is entitled to: Expect that all communication and records pertaining to your care is treated as confidential by the hospital, etc..."

5. An interview was conducted with the Medical Director of the ED on 10/5/21 at 2:46 p.m. When asked about initiating the MSE while patients remain in the waiting room of the ED, the medical director stated, "There is not much privacy in the ED. There are curtains between the beds in the ED, this is not any different. Privacy is not always possible." I explained a complaint was received concerning the MSE occurring in the waiting room of the ED. The medical director stated there is a room for the physicians to use while the patients are in the waiting room of the ED, a triage room if available. I explained the triage room was available during the tour of the ED waiting room, and I witnessed a MSE being initiated while the patient was in the waiting room. The medical director stated, "I agree with the triage room being used to initiate the MSE." The medical director concurred the MSE should not be initiated in the ED waiting room when other patients are in the waiting room.

B. Based on a review of the medical record, review of the "Code of Conduct" and staff interviews it was revealed the facility failed to ensure all ED staff followed all hospital policies and the "Code of Conduct." Due to a lack of communication with the ED medical staff involved in the alleged incident and the lack of other ED staff member's inability to verify the alleged incident did not occur with the emergency medical services (EMS) staff, there is lack of evidence to support the facility followed their "Code of Conduct" policy and procedure. This failure has the potential to adversely affect all patients seeking care in the ED and ensuring appropriate care is being provided to patients in a timely manner.

Findings include:

1. A review of the medical record for patient #1 revealed patient #1 was seen in the ED on 9/5/21. Patient #1's ED arrival time was 12:23 a.m. and the MSE was initiated at 12:35 a.m. Patient #1 was transported due to an active gastrointestinal (GI) bleed per EMS run sheet. Patient #1 was recently discharged from the facility on 9/4/21. Patient was diagnosed with hematemesis and anemia. EMS run sheet stated transfer of care time was 3:00 a.m.

2. A telephone call was attempted with the nurse practitioner (NP) on 10/5/21 at 1:55 p.m. I was unable to leave a message.

3. A telephone call was attempted with the NP on 10/5/21 at 2:00 p.m. I was unable to leave a message.

4. A telephone call was attempted with the NP on 10/5/21 at 2:40 p.m. I was unable to leave a message.

5. An interview was conducted with the Director of the ED at approximately 3:00 p.m. I explained I have been unable to reach the NP due to no answer to my calls. He/she stated she will attempt to call the NP to let him/her know I need to talk to him/her. He/she stated the charge nurse from 9/5/21 no longer works at the facility.

6. An interview was conducted with the Director of Risk Management on 10/6/21 at 8:00 a.m. The Risk Manager stated the NP is not answering the calls from the facility.

7. A telephone call was attempted with the NP on 10/6/21 at 9:29 a.m. I was unable to leave a message.

8. An interview was conducted with registered nurse (RN) #4 on 10/6/21 at 7:30 a.m. When asked about the alleged incident between EMS and the ED staff, RN #4 stated, "I did not see any part of it." When asked if training was received on EMTALA, RN #4 stated yes. RN #4 stated when the patient arrives on the property of the facility, then the patient is a patient of the facility. RN #4 stated you must triage each patient and take the seriously ill patients first. When asked if a gastrointestinal bleed would be considered a seriously ill patient to RN #4, RN #4 said yes.

9. An interview was conducted with RN #5 on 10/6/21 at 7:55 a.m. When asked about the alleged incident between EMS and the ED staff, RN #5 stated, "I did not see anything, only hearsay."

10. A review of the booklet titled "Common Ground Code of Conduct" stated in part: "Purpose of Our Code of Conduct, Our Code of Conduct provides guidance to all LifePoint Hospital employees and assists us in carrying out our daily activities within appropriate ethical and legal standards. The obligations apply to our relationships with patients, affiliated physicians, third-party payors, subcontractors, independent contractors, vendors, consultants, and one another. The Code is a critical component of our overall ethics and compliance program.... Clinical care is based on identified patient health care needs, not on patient or organization economics...Compassion and care are part of our commitment to the communities we serve."

11. A review of the policy titled "Covered Person Code of Conduct Training" dated 12/4/2019 stated in part: "Each Covered Person receives Code of Conduct training within 30 days of being hired and annually thereafter."

12. A review of the "Code of Conduct Training" revealed all ED staff received the Code of Conduct training.

13. An interview was conducted with the Medical Director of the ED on 10/5/21 at 2:46 p.m. When I explained that EMS reported the nursing staff stated patient #1 was not registered or their patient in the ED, but the patient was on a stretcher in the ED and the MSE was started within twelve (12) minutes of the patient's arrival to the ED, the medical director stated, "Once the MSE is started they are our patient." I explained once on the property, the patient is a patient of the facility. When asked about a possible incident between EMS and the ED staff on 9/5/21, the medical director stated there are always two (2) sides to every story. I stated yes, but you have to be able to hear both sides to a complaint. I explained I have not been able to speak to the NP due to no answer to my phone calls and per the hospital administration staff, the NP has not answered their attempts to reach the NP. The medical director suggested talking to the charge nurse, and I explained the charge nurse no longer works at the facility. The medical director stated well then it is what it is. The medical director stated I will send the NP a text and try to have the NP return my call. I do not want EMS staying with patients in the ED, but if they do not have enough nurses in the ED then we do the best we can do. Medical staff should want to get the EMS squads out of the ED. When asked about the code of conduct of the medical staff, the medical director stated it should be professionalism, hold their emotions in hold, it is about patient care. This was not appropriate conduct. There was an emotional flare, and the nursing staff were still upset the next day. They get very few complaints on the professional's attitude. This is not a pattern of the medical staff in the ED. She/he concurred this would not be appropriate conduct of the medical staff.