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Based on Emergency Department documents review, medical records review, and staff interviews, the Critical Access Hospital failed to provide an appropriate Medical Screening Examination on patients who presented with an Emergency Medical Condition.


Findings:


1. On the afternoon of 10/29/2014, surveyors reviewed the medical record for patient #5. The medical record for patient #5 showed that the patient presented to the ED after a fall with complaints of left hip pain. The medical record documented that the patient received x-rays in the ED and was discharged back to the nursing home.


2. The medical record for this patient at another hospital that patient #5 was brought to 2 days after being discharged from the ED of this hospital, where surgery was performed to repair the fracture of the left hip of this patient.


3. The medical record for patient #5 contained no documentation that the attending Emergency Room physician read the preliminary x-rays prior to discharging the patient back to the nursing home where she lived.


4. The medical record for patient #5 contained documentation from the hospital's radiologist of two fractures, a left hip fracture and a right wrist fracture. The results from the hospital's radiologist were posted to the medical record on the day after the patient had been seen in the Emergency Department.


5. On the afternoon of 10/29/2014, two Emergency Room physicians told surveyors that they always read the preliminary x-rays, then the x-rays are read by a radiologist. On the morning of 10/30/2014, one emergency room Physician Assistant (PA), told surveyors that she always reads the preliminary x-rays, then the x-rays are read by a radiologist.


6. On the afternoon of 10/29/2014, surveyors requested and reviewed all Emergency Department Policies and Procedures.


Although diagnostic radiologic tests were performed, the hospital staff failed to consider the results of those test coupled by the presenting symptomatologies, limited range of motion and pain aggravated by mobility before discharging the patrient back to the nursing home.

Based on policy and procedure review, medical records review, and staff interviews, the Critical Access Hospital inappropriatelty discharged a patient with an unstable emergency medical condition (EMC).


Findings:

1. The medical record, from another hospital, of patient #5 showed that on 09/16/2014, "...This patient presented to our hospital (on 09/15/2014) following an injury that resulted in a left intertrochanteric fracture. The implications of the injury were discussed with the patient and the available family to the best extent of their understanding. The options were discussed. The decision was made to proceed with surgery...The patient was taken to the operating room..."


2. The medical record of patient #5 contained documentation by the physician on 9/13/2014 at 1017, "...pain is present in the right wrist and left upper leg. The quality of the pain is constant. The pain is at a severity of 6/10. The pain is moderate. Associated symptoms include limited range of motion. The symptoms are aggravated by activity..."


3. On the afternoon of 10/29/14, surveyors reviewed emergency department medical records. The medical record for patient #5 contained documentation that a right wrist x-ray and a left hip x-ray were performed in the emergency department on 9/13/2014. There was no documentation that the emergency department physician read the preliminary x-rays. There was documentation that the patient was discharged home.

4. The medical record for patient #5 contained documentation from the hospital's radiologist that showed a fractured right wrist and a fracture left hip on the day after the patient was seen in the emergency department.

5. On the afternoon of 10/29/14, a registered nurse told surveyors that the emergency department physician, reviews the preliminary x-rays and the x-rays are sent to the radiologist to read.

6. On the afternoon of 10/29/14, one emergency department physician told surveyors he reads his own x-rays and the radiologist will do an over-read either verifying the findings or noting a discrepancy. The physician told surveyors if there was a discrepancy the radiologist use to fax reports to the ED providers. He informed surveyors that he has not received a fax in a long time.

7. On the afternoon of 10/29/14, surveyors requested and reviewed all emergency department policies and procedures.


Although diagnostic radiologic tests were performed, the hospital staff failed to consider the results of those test coupled by the presenting symptomatologies, limited range of motion and pain aggravated by mobility before discharging the patrient back to the nursing home. Consequently, this hospital failed to recognize the emergent nature of the patient's injury prior to discharge, which resulted in a surgical repair at another hospital.