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Based on staff interview, video surveillance review, medical record event log review, medication reconciliation report review, document review of physician order and email, staffing schedules, and facility policy and procedure review, the facility failed to provide an appropriate medical screening exam (MSE) for two (2) of 20 patients reviewed. Patients #1 and #5.

Findings Include:

Cross Refer to C2406 for the facility's failure to provide an appropriate medical screening exam (MSE) for Patients #1 and #5 within the capability of the hospital Emergency Department.

During exit conference on 10/27/2022 at 1:30 p.m. with Chief Executive Officer (CEO) survey findings were discussed. No further documentation was submitted for review.

Based on staff interview, video surveillance review, medical record event log review, medication reconciliation report review, document review of physician order and email, staffing schedules, and facility policy review, the facility's Emergency Department (ED) failed to provide a Medical Screening Exam (MSE) for two (2) of 20 patients reviewed. Patients #1 and #5.

Findings Include:

Patient #1:
Observation of facility video surveillance footage of facility's ambulance bay on 07/12/2022 at 7:37:14 p.m. confirms ambulance at the facility's ambulance bay, ambulance's rear doors are open, Registered Nurse (RN)#1 present and appears to be speaking with Emergency Medical Services (EMS) Crew. RN #1 exited ambulance bay and entered facility at 7:37:57 p.m. Ambulance exited facility at 7:40:08 p.m.

Interview with Chief Executive Officer (CEO) on 10/25/2022 at 11:08 a.m. confirmed Patient #1 did present to the facility's Emergency Department (ED) on 07/12/2022 around 7:30 a.m. via Emergency Medical Services (EMS) transport and Patient #1 did not receive a medical screening exam (MSE). CEO reports Patient #1's Primary Physician, Physician #2 orders were to transport patient to Facility #2 due to obstruction of suprapubic catheter. The CEO also confirms when EMS arrived with Patient #1, RN #1 talked with Ambulance Crew Member #1 and instructed the EMS crew they were not accepting Patient #1 because they do not have Urology Services and the patient should be taken to Facility #2.

Interview with RN #1 on 10/25/2022 at 3:21 p.m. confirms Patient #1 arrived in an EMS transport ambulance on 07/23/2022, at approximately 8:07 a.m. with complaint of problems with suprapubic catheter. RN #1 confirms she walked to the ambulance and talked with Ambulance Crew Member #1 letting them know the facility was not accepting Patient #1 because they do not have Urology Services and the patient should be taken to Facility #2. RN #1 said she observed the patient resting on the stretcher and did not think the patient was in distress.

Record review for Patient #1 revealed no medical record documents for 07/12/2022. No medical record presented for review.

Review of physician order from Physician #2 dated 07/12/2022 at 7:03 p.m., confirms, "send Patient #1 to Facility #2 related to thick, cloudy, foul odor, and obstruction to suprapubic catheter for evaluation."

Review of email dated 07/25/2022 at 12:15 p.m. from Hospital Physician #1 to the Administrator, confirms Facility #1 telling EMS they could not accept patient due to patient needing a Urologist.

Review of Emergency Department staffing sheet for 07/12/2022 for hours of 07:00 a.m. through 7:00 PM revealed one (1) Nurse Practitioner and two (2) Registered Nurses on duty.

Patient #5:

Review of Patient #5's Medical Record "Event Log" for 05/12/22 reveals Patient #5 arrived at the ED on 05/12/2022 at 8:21 a.m. for a urinary catheter change. Patient #5 was registered at 8:24 a.m. and left the facility at 9:16 a.m.

Record review of "Medication Reconciliation Report," revealed patient was not triaged and left without being seen at 9:16 a.m. No other documented evidence was available.

During an interview on 10/27/22 at 11:15 a.m., Nurse Practitioner (NP) #1 confirmed he was working the morning of 05/12/2022. NP #1 does not recall seeing Patient #5 that morning, but he was familiar with the patient. NP #1 revealed Patient #5 was not there when he was called to come into triage room and must have left the facility. NP #1 revealed the departure time of 9:16 a.m.

Review of Emergency Department Policy and Procedure, "Emergency Department Medical Screening Examination," dated 2013, " ...The purpose of a medical screening examination (MSE) is to confirm or rule out the presence of an emergency medical condition ...".

Review of Emergency Department Policy and Procedure, "Triage", dated July 2013, " ...In order to provide an efficient, systematic means of establishing the nature, quality and severity of every patient's chief complaint and the level of intervention required, each patient presenting to the Emergency Department (ED) will be seen, evaluated, triaged, and prioritized according to their needs by a Registered Nurse ...".

Review of Emergency Department policy and procedure, "Emergency Medical Treatment & Labor Act", dated July 2013, " ...Medical Screening Examination. If a person comes to the Hospital and a request is made for their emergency care or, if the person is in need of emergency care, then qualified medical personnel will, ...conduct and document an appropriate medical screening examination ....".

During exit conference on 10/27/2022 at 1:30 p.m. with Chief Executive Officer (CEO), survey findings were discussed. No further documentation was submitted for review.