HospitalInspections.org

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Based on observation, interview, record review, and review of hospital policies and procedures and medical staff bylaws, the hospital failed to develop and implement policies and procedures for evaluation and treatment of patients presenting for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health care outcomes, injury, and death.

Findings included:

1. The hospital failed to ensure that the medical staff bylaws identified the qualifications for physicians and mid-level providers who performed medical screening examinations in the emergency department.

2. The hospital failed to ensure that emergency department staff members sent copies of all medical records pertaining to the patient's emergency care to the receiving facility when patients were transferred to another hospital.

Cross Reference: Tags A-2406, A-2409
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Based on interview, record review, and review of hospital policies and procedures and medical staff bylaws, the hospital failed to ensure that the medical staff bylaws identified the qualifications for physicians and mid-level providers who performed medical screening examinations in the hospital's emergency department.

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health care outcomes, injury, and death.

Reference: 42 CFR 482.55(b)(2) - "The hospital must staff the emergency department with the appropriate numbers and types of professionals and other staff who possess the skills, education, certifications, specialized training and experience in emergency care to meet the written emergency procedures and needs anticipated by the facility."

Findings included:

1. Review of the hospital's policy and procedure titled "EMTALA", policy #14.2.004 reviewed 02/28/19, showed that the hospital's governing body had designated physicians and mid-level providers (nurse practitioners and physician assistants) acting within their scope of licensure were qualified to perform medical screening examinations in the hospital's emergency department (ED).

2. Review of the hospitals' medical staff bylaws dated 04/21/16 showed that the bylaws did not include the qualifications for physicians and mid-level providers who performed medical screening examinations in the hospital's emergency department.

3. On 08/13/19 during an interview with the investigator, the hospital's Chief Nursing Officer (Staff #1) confirmed that the bylaws did not identify the qualifications for physicians and mid-level providers who performed medical screening examinations in the hospital's emergency department.
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Based on interview, medical record review, and review of hospital policies and procedures, the hospital failed to ensure that emergency department staff members sent copies of all medical records pertaining to the patient's emergency care to the receiving facility when patients were transferred to another hospital, as demonstrated by 2 of 7 patients reviewed (Patient #1, #2).

Failure to send copies of medical records, including the physician or mid-level provider's assessment of the patient, nursing documentation, medications and treatments administered, and laboratory and radiology results risk medical errors and adverse patient outcomes due to lack of care continuity.

Findings included:

1. Review of the hospital's policy and procedure titled "EMTALA", policy #14.2.004 reviewed 02/28/19, showed that when patients were transferred from the emergency department (ED), copies of all medical records related to the patient's emergency condition would be sent to the receiving hospital.

2. Review of the records of seven patients who were transferred to another hospital after a medical provider completed a medical screening examination and provided stabilizing treatment showed the following:

a. Patient #1 was a 64 year-old patient who was admitted to the hospital's ED on 02/14/19 with symptoms of a stroke. The patient underwent an electrocardiogram (EKG), coaxial tomography (CT) of his head and neck scan, and laboratory blood testing. ED nursing staff gave the patient alteplase 200 mg (a drug to dissolve blood clots) intravenously, and aspirin 81 mg (an anticoagulant) by mouth. The patient's medical record included an ED transfer form. The form had an area that read, "ED clinical records sent with" and check boxes for "Provider Summary", "Nurses Notes", "Flow [Sheets]", "Treatment Provided", and "Medications/Fluids Administered". None of the boxes was checked on the transfer form. No additional entries were found in the patient's record indicating the medical records had been sent to the receiving hospital when the patient was transferred.

b. Patient #2 was a 39 year-old patient who was admitted to the ED on 02/25/19 with severe swelling and leg pain. The patient also had stage 4 chronic kidney disease and type 2 diabetes mellitus. The patient underwent a chest x-ray, laboratory blood testing, a urinalysis, and an EKG. ED nursing staff gave the patient ceftriaxone 2 grams (an antibiotic) intravenously in normal saline. The "Provider Summary" had been checked on the ED transfer form in the patient's record, indicating it was sent with the patient to the receiving hospital when the patient was transferred. The check boxes on the form had not been checked for "Nurses Notes", "Flow [Sheets]", "Treatments Provided", and "Medications/Fluids Administered". No additional entries were found in the patient's record indicating these had been sent to the receiving hospital when the patient was transferred.

3. On 08/13/19 at 3:00 PM during an interview with the investigator, the hospital's Chief Nursing Officer (Staff #1) confirmed that there was no evidence in the medical records above that all of the ED records had been sent to the receiving hospital when the patient was transferred.
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