HospitalInspections.org

Based on review of facility policy, review of a facility video recording, review of Emergency Department logs, review of facility documentation, and interview, the faciity failed to maintain an accurate Emergency Department log and failed to provide a medical screening for one patient (#5) of 31 patients reviewed.

The findings included:

Refer to A-2405 for failure to maintain an Emergency Log.

Refer to A-2406 for failure to provide a medical screening examination.

Based on review of facility policy, review of an Emergency Department (ED) lobby video recording, review of the Emergency Department logs, review of facility documentation, and interview, the facility failed to ensure an accurate emergency room log was maintained for one patient (#5) of 31 patients reviewed.

The findings included:

Review of facility policy "Emergency Medical Treatment & Active Labor Act (EMTALA) Guidelines" revised on 6/2014, revealed "...all patients presenting to the ED requesting evaluation and treatment will be logged in the ED log...the ED log will include the disposition of the patient and will indicate whether these individuals...refused treatment...treated...admitted...transferred...discharged...disposition and patient condition will be listed on the log..."

Review of an ED lobby video recording electronically dated 4/14/17 revealed the following: at 00:50:57 a female wearing jeans with a purse around her neck and long brown hair and a male wearing jeans and a black jacket enter the ED through the main entrance. Continued review revealed at 00:51:04 the female and the male (Patient #5) walked up to the registration desk and at 00:51:09 the female spoke to the ED employee sitting at the registration desk. Further review revealed the female and Patient #5 walked away from the registration desk and exited the ED through the main entrance doors.

Review of the ED Central Log for 4/13/17-4/14/17 revealed Patient #5 was not listed on the ED log.

Review of a facility investigation dated 4/14/17, not timed, revealed "...[family member of Patient #5] called stating that [Patient #5] came to the ED last night with an asthma attack...[Patient #5] informed her [family member] the person at the front desk told them to fill out the papers and that they had a 6 ½ hr [hour] wait. There is no record of the patient signing in for service on this date...she [family member] was very concerned that we would tell someone who was having an asthma attack to fill out papers...she feels as though he [Patient #5] should have gotten immediate treatment..."

Review of a facility investigation dated 4/24/17, not timed, revealed "...identified employee working the night of 4/13/17 [4/14/17]...met the description of person identified by patient [Patient #5] and wife. Employee vaguely remembered a man and woman coming to the counter. Lobby was full... she thinks that she possibly did a quick oxygen saturation check on the gentleman and it was 98% but she cannot be certain this is the same person. She remembers that the couple left immediately after that..."

Interview with the Chief Nursing Officer (CNO) on 4/25/17 at 8:10 AM, in the administration conference room, revealed "...I spoke with the [named ED technician] and she vaguely remembers the patient and his wife coming in on 4/14/17...early in the morning...she said she thought she checked the patient's oxygen saturations but does not think she documented it anywhere..." Further interview revealed "...[named ED Technician] said they asked her how long the longest patient had waited in the ED and she said she told them 6 and a half hours...she said she encouraged them to sign in and be triaged but they would not stay..."

Telephone interview with ED Technician #1 on 4/25/17 at 9:20 AM revealed "...we were very busy that night [4/14/17] and the ED was full...the patient [Patient #5] came in with a compliant of an Asthma attack...according to the patient's wife...I used the oxygen monitor but I don't remember what it was...it did not show anything acute...it had to be 97% or above and the heart rate had to be between 80-120/min..."

Telephone interview with the Administrator, the CNO, and Risk Manager on 4/26/17 at 3:40 PM confirmed the patient was not listed on the ED Central Log.

Based on review of facility policy, review of the ED (Emergency Department) lobby video recording, review of facility documentation, and interview, the facility failed to provide a medical screening examination for one patient (#5) of 31 patients reviewed.

The findings included:

Review of facility policy "Emergency Medical Treatment & Active Labor Act (EMTALA) Guideline, last revised 6/2014, revealed "...EMTALA refers to Federal Emergency Medical Treatment and Active Labor Act that requires hospitals to provide emergency screening medical examinations, stabilization to all patients presenting to the hospital requesting such services..." Further review revealed "...a Medical Screening Examination [MSE] will be performed for any individual that [1] presents on hospital property and requests examination or requires treatment for what may be an emergency medical condition; [2] has such a request for examination or treatment made on his or her behalf; or [3] appears to require emergency examination or treatment based on his/her appearance or behavior...[MSE] are provided regardles of diagnosis...financial status...race...color...national orgin...disability..."

Review of an ED lobby video recording electronically dated 4/14/17 revealed the following: at 00:50:57 a female wearing jeans with a purse around her neck and long brown hair and a male wearing jeans and a black jacket enter the ED through the main entrance. Continued review revealed at 00:51:04 the female and the male (Patient #5) walked up to the registration desk and at 00:51:09 the female spoke to the ED employee sitting at the registration desk. Further review revealed at 00:51:18 the female and Patient #5 walked away from the registration desk and exited the ED through the main entrance doors. Continued review revealed Patient #5 was not assessed by a qualified individual.

Review of a facility Investigation dated 4/14/17, not timed, revealed "..[Patient #5's family member] called stating that...[Patient #5] came to the ED last night [ with an asthma attack. She related that he [Patient #5] informed her [family member] the person at the front desk told them to fill out the papers and that they had a 6 ½ hr [hour] wait. There is no record of the patient signing in for service on this date...she was very concerned that we would tell someone who was having an asthma attack to fill out papers...she feels as though he should have gotten immediate treatment..."

Review of a facility investigation dated 4/24/17, not timed, revealed "...identified employee working the night of 4/13/17 [4/14/17]...met the description of person identified by patient [Patient #5] and wife. Employee vaguely remembered a man and woman coming to the counter. Lobby was full...the employee said that she asked them to sign in...She [employee] thinks that she possibly did a quick oxygen saturation check on the gentleman and it was 98% but she cannot be certain this is the same person. She remembers that the couple left immediately after that..."

Interview with the Chief Nursing Officer (CNO) on 4/25/17 at 8:10 AM, in the administration conference room, revealed "...I spoke with [named ED technician] and she vaguely remembers the patient and his wife coming in on 4/14/17...early in the morning...she said she thought she checked the patient's oxygen saturations but did not document it anywhere..."

Telephone interview with ED Technician #1 on 4/25/17 at 9:20 AM, revealed "...we were very busy that night and the ED was full...the patient came in with a compliant of Asthma attack, this was according to the patient's wife...I used the oxygen monitor but I don't remember what it was...it did not show anything acute...it had to be 97% or above and the heart rate had to be between 80-120/min..." Further interview revealed "...I told the wife he was breathing good according to the O2 saturations...they were alarmed that the waiting room was full...I told them to check in and see the triage nurse and based on that the triage nurse would make the decision...the wife asked how long people had been waiting and I told her 6 hours but I did not mean that the patient will wait that long...his [Patient #5's] wife stated 'that's ridiculous' and said they would go somewhere else...I tried to explain the process to them but they left..."

Interview with the ED Medical Director on 4/25/17 at 1:40 PM, in the administration conference room, confirmed any patient who comes into the ED for treatment should be given a medical screening evaluation.

Telephone interview with Patient #5's wife, on 4/26/17 at 10:00 AM, revealed the patient [Patient #5] presented to the ED on 4/14/17 between the hours of 12:00 AM and 2:00 AM. Further interview revealed the both the patient and the patient's wife were wearing blue jeans; the patient's wife had long brown hair and the patient's wife had a purse around her neck; the patient was wearing a black jacket and had sandy short hair. Further interview revealed "...my husband has a history of asthma, Chronic Obstructive Pulmonary Disease [COPD], and emphysema [chronic lung disease]...he was having an asthma attack and needed to be seen...we came into the emergency room and walked to the front desk...there was a young lady sitting there...I told her my husband needed to be seen and she told me to fill out the white paper...she told me the wait was about 6 and one and half hours...I told her we could not wait that long...I did not fill the paper out and we just turned around and left..." The interview revealed the description of the patient and the patient's wife was the same as the male and female observed on the video recording.

Telephone interview with the Administrator, the CNO, and the Risk Manager on 4/26/17 at 3:40 PM revealed they had reviewed the video recording. Further interview confirmed the patient presented to the ED lobby desk and spoke with ED Technician #1 and she did not check Patient #5's oxygen saturation check. Further interview confirmed the patient left the ED without a medical screening examination and the facility failed to follow facility policy.