HospitalInspections.org

Based on observation and staff interview conducted on April 14, 2015, it was determined that the facility failed to conspicuously post signage specifying the rights of individuals under section 1866 of the Act with respect to the examination and treatment of emergency medical conditions and women in labor.

Findings include:

1. Observation of the Hospital main entrance/lobby revealed that no signage was posted.

2. Observation of the Emergency Department (ED) entrance revealed that no signage was posted.

3. Observation of the ED main entrance waiting room/lobby, revealed one sign posted in an area that is not visible from where all patients are seated.

4. Observation of the main ED ambulance entrance revealed that no signage was posted.

5. Observation of the Triage Hallway revealed one sign. The sign was not conspicuously posted and the font was small, making visualization difficult.

6. Observation of the Triage rooms revealed that no signage was posted.

7. Observation of the Fast Track rooms revealed that no signage was posted.

8. Observation of the Registration area revealed that no signage was posted.

9. Observation of the main ED rooms revealed that no signage was posted.

11. Observation of the Seclusion room revealed that no signage was posted.

12. The above findings were confirmed by Staff #3.

13. Upon interview with Staff #4, she/ he stated that 18.37% of the ED population is Hispanic.

14. It was observed that none of the EMTALA signs were in Spanish.

Based on a review of the ED physician on-call lists and staff interview, it was determined that the facility failed to ensure that the physician on-call list, which identifies the name of an individual physician on-call for a specialty, is maintained.

Findings include:

1. Review of the on-call list for Urology revealed that a physician group was listed as on-call for January-December 2014 and January-December 2015.

a. A specific physician was not listed.

2. The above finding was confirmed by Staff #4.

Based on medical record review, review of ED logs, and staff interview, it was determined that the facility failed to ensure that all entries in the ED logs are accurate.

Findings include:

1. In Medical Record #21, under disposition, it was documented that the patient left AMA (against medical advice).

a. The ED Log entry for Patient #21 stated that the patient left before medical screening.

b. The ED Log entry does not match the disposition recorded in the medical record.

c. This finding was confirmed by Staff #4.

Based on medical record review, review of facility policies and procedures, and staff interview, it was determined that not all patients presenting to the ED are provided a medical screening exam by qualified medical personnel.

Findings include:

Reference: Emergency Room ESI policy states, "... 3. Triage of Patients Complaining of Chest Pain: Patients meeting the following criteria whose chief complaint is chest pain are to have an EKG (electrocardiogram) done within 10 minutes of arrival to the Emergency Department. The Healthcare Professional triaging the patient must facilitate this process. This may involve "stopping" the current triage process, taking the patient to the treatment area and having an EKG done. The physician would then evaluate the EKG and decide where the triage process would continue ..."

1. Medical Record #6 -- The patient was brought to the ED via ambulance, at 2136 on 12/22/14, for chest pain times 2 hours.

a. The patient received an Electrocardiogram at 2222; forty-six minutes after arrival to the ED.

b. The physician was shown the EKG at 2236; sixty minutes after arrival to the ED.

c. The facility failed to provide an appropriate medical screening exam for this patient, as per facility policy.

d. This finding was confirmed by Staff #2.

2. Medical Record #27 -- The patient arrived to the ED, on 2/23/15 at 1309, and was triaged at 1309. The patient left the ED at 1809, five hours after arrival.

a. There was no documentation of a medical screening exam having been completed by a qualified medical professional for this patient.

3. Medical Record #29 -- The patient arrived to the ED, on 8/15/14 at 1215, and was triaged at 1248. The patient left the ED at 2016, eight hours after arrival.

a. There was no documentation of a medical screening exam having been completed by a qualified medical professional for this patient.

4. Medical Record #1 -- The patient arrived to the ED, on 2/15/15 at 0737, and was triaged at 0816. The patient was assigned an ESI level of 4. Via ultrasound, it was confirmed that the patient was 36 weeks pregnant.

a. There was no evidence that a qualified medical professional ruled out imminent delivery prior to the recommendation of transfer to another facility for this patient.

b. The patient delivered in the ED while awaiting transport.

c. Fetal heart monitoring was not utilized in the ED while the patient was awaiting transport.

5. Medical Record #4 -- The patient arrived to the ED, on 3/2/15 at 1729, and was triaged at 1843. The patient was assigned an ESI level of 2. The patient was 31 weeks pregnant.

a. There was no evidence that a qualified medical professional ruled out imminent delivery prior to the recommendation of transfer to another facility for this patient.

b. Fetal heart monitoring was not utilized in the ED while the patient was awaiting transport.

c. The patient was transferred from the ED at 1901.

6. Medical Record #18 -- The patient arrived to the ED, on 2/10/15 at 1218, and was triaged at 1240. The patient was given an ESI level of 3. The patient was 32 weeks pregnant.

a. There was no evidence that a qualified medical professional ruled out imminent delivery prior to the recommendation of transfer to another facility for this patient.

b. Fetal heart monitoring was not utilized in the ED while the patient was awaiting transport.

c. The patient was transferred from the ED at 1643.

7. Medical Record #19 - The patient arrived at the ED on 2/15/15 at 0001 and was triaged at 0013. The patient was given an ESI level of 3. The patient was "roughly 14-18 weeks" pregnant.

a. There was no evidence that a qualified medical personnel ruled out imminent delivery prior to the recommendation of transfer to another facility for this patient.

b. Fetal heart monitoring was not utilized in the ED while the patient was awaiting transport.

c. The patient suffered a miscarriage and was transferred from the ED at 0605.

8. A request was made by this surveyor to Staff #4 and Staff #15, for an ED Labor and Delivery policy and procedure. None was provided.

9. Staff #4 confirmed the above findings.

A. Based on review of Medical Records #1, #2, #9, #18 and #24, it was determined that the facility failed to ensure that all transfers are conducted appropriately.

Findings include:

1. Medical Record #1 failed to include the risks of the transfer on the transfer form.

2. Medical Record #2 and #9 contained no evidence of a transfer form.

3. In Medical Record #18, the consent for transfer was not checked on the transfer form.

4. Medical Record #24 failed to include the patient's signed consent to transfer.

5. In Medical Record #3, the transfer form for Medical Record #31 was discovered.


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B. Based on staff interviews, review of medical records and review of facility policies and procedures, it was determined that the facility failed to ensure that transfer to the receiving medical facility is appropriate.

Findings include:

Reference #1: Facility policy, Newborn Transfer, states, "... 1. ... b. Call Newark Beth Israel Neonatal Transport team to make arrangements for the transport ... 2. Well babies and their mothers should be transported to Lifestar for transportation of the mother and child. ... "

Reference #2: Facility policy, Transfer of Patients and Neonates, states, "... C. Transfer and Care of an emergency department delivery ... The Neonatal Intensive Care Unit is contacted at Newark Beth Israel ... "

1. Review of Medical Records #1 and #2 revealed that the neonate, Patient #2 and his/ her mother, Patient #1, were not transferred to Newark Beth Israel as per facility policies. Patients #1 and #2 were transferred to another facility.

2. Review of Medical Records #19 revealed that this pregnant patient was not transferred to Newark Beth Israel as per facility policies. Patient #19 was transferred to another facility.