HospitalInspections.org

Based on interview, record review and surveillance video review, it was determined the facility failed to provide a medical screening exam (MSE) for one (1) of twenty-one (21) patients who presented to the hospital seeking emergency care. Specifically, Patient #21 was turned away by a security guard when seeking emergency care at the facility and ultimately treated at another hospital.

The findings include:

A surveyor review of the medical record for Patient #21 on 06/22/2022 revealed the patient arrived at another hospital facility on 05/09/2022 at 2:59 a.m with a chief complaint of shortness of breath. An interview with SM #16, the ED Director of that hospital, revealed that during "morning handoff" the charge nurse informed SM #16 that Patient #21 reported being turned away from the ED at INOVA Mount Vernon Hospital before arriving at their facility. SM #16 "submitted the incident into the safety reporting platform, which sparked a formal investigation."

When discussing the investigation with SM#2, surveyors learned that a facility investigation was conducted from 5/12/2022 through 6/1/2022. The investigation indicated that INOVA Mount Vernon Hospital went on "restricted access" due to a safety issue at the hospital. Patient #21 arrived at the hospital to seek emergency medical care during this time and SM#21 advised that the facility was closed. It was determined the facility was on Restricted Access from 1:45 a.m. until 2:50 a.m on 05/09/2022.

Surveyors conducted an interview with SM #12, an employee of INOVA Mount Vernon Hospital (Security Account Manager), on 6/22/2022. SM #12 advised the following: "A patient came in attacked by a machete... clinical requested to go restricted access... a call is made to a central switchboard, who are able to page any of the system's facilities overhead... [SM #21] was sitting behind the registration desk when a nurse announced lock down, no one in or out... [SM #21] went and stationed at the ED entrance... shortly after, an individual approached [SM #21] asking if the ED was open and [SM #21] responded "no", so the individual left in their vehicle... later we learn the individual sought care at [another facility]."

On 06/22/2022 surveyors reviewed the video footage for Patient #21 incident from 05/09/2022. The video showed a vehicle parked in front of the Facility entrance, an individual exits the vehicle and walks around toward the facility. Approximately twelve to fifteen (12-15) seconds later, the individual is seen walking back towards the vehicle, gets in the driver's seat, and drives away. There was only one individual viewed in the frames of the video and there was no visualization of the individual speaking with someone.

SM#12 further advised, "when I was made aware, an investigation was conducted... immediate action was taken in response to the report... the action included retraining all the security officers on the EMTALA policy and regulations and re-education/training on the restricted access procedure versus lock down procedure... there was no "sign in" sheet to document the re-education/training of the restricted access versus lock down procedure... it was verbal communication that occurred with the shift supervisors and security officers during huddles... I attended majority of the huddles to ensure the re-education was provided."

SM#12 was unable to provide surveyors with documentation of staff re-education on the restricted access procedure versus lock down procedure. Surveyors attempted to conduct an interview with SM #21, the security guard who turned the patient away on 05/09/2022, to determine if re-education regarding this incident was conducted and comprehended. However the facility advised they were unable to get into contact with that staff member.

The facility was in the process of finalizing a policy specific to restricted access and lock-down. However the policy was not yet finalized, implemented, or distributed to staff at the time of the survey. There was no evidence provided that staff had been educated on policy currently in development. The facility also reported that other tools, such as a quick reference tool, were still in development.

A review of the facility policy titled "Facility Protective Actions: Lockdown, Restricted Access, Shelter-in-Place" states in part:

"If restricted access into the Emergency Department, clinical leadership should provide clear guidance to Security team members and consider placing a clinical team member with the Security team member to ensure compliance with Inova's compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) Policy."

A review of the facility policy titled "EMTALA - Compliance with the Emergency Medical Treatment and Active Labor Act" states in part:

"... any individual who is on Inova Hospital Property other than in a Dedicated Emergency Department, and who requests, or whom a request is made, examination or treatment for an emergency condition, shall be given an appropriate medical screening."