HospitalInspections.org

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Based on record review, observation, and interview during the Federal Survey, the Emergency Department (ED) staff failed to ensure that walk-in patients who presented to the ED were: (a) assessed prior to triage, and (b) continuously monitored after triage but before being provided with an Emergency Medical Screen Examination in fifteen (15) out of twenty-three (23) Medical Records reviewed (Patients #28, #29, #30, #31, #32, #33, #34, #35, #37, #38, #41, #43, #44, #46 and #47).

Findings:

(a) Review of the "Quick" Registration Form revealed that Patient #29 presented to the Emergency Room on 01/03/13 at 6:13PM with complaints of chest pain. No further documentation is noted until 11:00PM when the patient is listed as discharged without being seen.

Review of the "Quick" Registration Form for Patient #30 revealed the patient presented on 04/1613 at 1:43PM with complaints of difficulty breathing. No further documentation is noted until 11:00PM when the patient is listed as discharged without being seen.

Review of the "Quick" Registration Form revealed that Patient #34 presented on 07/18/13 at 3:18PM with complaints of chest pain. No further documentation is noted until 11:50PM when the patient is listed as discharged without being seen.

Similar findings were identified in Medical Record reviews for Patients #28, #31, #32 and #33.

During the tour of the Adult Walk-In Emergency Room Triage Area on 02/12/14 at 10:30AM Staff Member #17 stated on interview "I ask the person why they are here, their date of birth, and first then last name which are entered into the system. I then tell them to take a seat to wait for the Nurse and give them a Registration Form to complete while they wait. If they complain of three (3) or four (4) of the things on the list (ED Registration Process), I must tell the Nurse right away. "

Review of the "ED Registration Process" (Instruction Sheet) documents that Security greets the patient and directs them to Room #3 for Registration. The Registrar will ask the patients why they are being seen and is to interrupt the ED staff if anyone complains of chest pain, shortness of breath, is under three (3) months of age, has epigastric pain or looks sick. Otherwise they complete the Triage Quick Registration (then sit in the Triage Waiting Area in front of the Triage Cubicles).

On 02/19/14 at approximately 11:30AM Staff Member #9 stated that after a patient "Quick" registers, the patient waits in the Waiting Room until the Triage Nurse calls their name. If the patient doesn't answer, the Triage Nurse tries to call/find the patient every fifteen (15) minutes until three (3) tries have been made. She then stated that this was not a written policy, but a practice. Staff #9 then stated there is "no Patient Record" because the patient has not been triaged yet, and therefore no place for the Nurse to document what time or how many tries were attempted to call/find the patient in the Waiting Room. Staff #9 also stated because there was no place to document the attempts, there is no record of how long it took from the patient's "Quick" Registration until the Triage Nurse actually went to triage them. Therefore there is no way to track how long the patients waited to see the Triage Nurse, after Quick Registering, before walking out of the facility.

This interview was conducted with Staff Member #16 who also confirmed the above information.

(b) Patient #46 presented on 11/14/13 with a chief complaint of right calf pain and swelling. The patient also complained of being occasionally short of breath for the past two (2) weeks.
The patient was registered at 6:36PM and triaged at 7:26PM with an Acuity Level III, fifty (50) minutes later.

Patient #47 presented on 11/14/13 with a chief complaint of abdominal pain and dizziness. She states that she is possibly pregnant and has had left lower quadrant pain. The patient was registered at 6:35PM as an Acuity Level II, but was triaged at 7:10PM, thirty-five (35) minutes later.

Patient #35 presented on 02/06/14 with a chief complaint of palpitations "for months". She states that she was sent by her Primary Medical Doctor. The patient was registered at 12:24PM and was triaged as an Acuity Level III at 1:10PM, forty-six (46) minutes later.

Patient #37 presented on 02/06/14 with a chief complaint of being treated for a blood infection for three (3) weeks. The patient states that during the night he had "itching and uncontrollable chills". The patient was registered at 12:07PM and was triaged with an Acuity Level II at 12:37PM, thirty (30) minutes later.

Additional findings were identified in Medical Record reviews for Patients #38, #41, #43 and #44.

These findings were confirmed on 02/19/14 with Staff Member #18 during review of each Medical Record.

Review of the Policy titled "Triage" dated 08/13/13 revealed "all patients presenting to the ED will undergo the triage process" and a priority level will be documented with Level II defined as a high risk situation and Level III requiring many resources". The Policy does not include the Quick Registration Process.

The Policy titled "Patient Initial Screening" dated 08/13/13 states that "the initial screening examination will be completed under the supervision of an Attending Physician after the patient has been triaged".