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Based on review of facility documents, medical records (MR), and interview with staff (EMP), it was determined the facility failed to ensure good management techniques were implemented in the Emergency Department to prevent personal discomfort of the patient in one of 25 emergency medical records reviewed (MR1).

Findings include:

Review on August 22, 2012, of the facility policy "Patient's Bill of Rights/Responsibilities", dated revised January 2011, revealed "As a health care facility, we are committed to delivering quality medical care to you, our patient, and to making your visit pleasant as possible. The following "Statement of The Patient's Rights" was developed by the Department of Health, Commonwealth of Pennsylvania, and is endorsed by the administration and staff of this health care facility. As it is our goal to provide medical care that is effective and considerate, we submit this to you as a statement of our policy. ...13. A patient has the right to appropriate assessment and management of pain. ..."

Review on August 22, 2012, of facility's patient handout "Statement of Patient Rights and Responsibilities," revealed "As a healthcare facility, we are committed to delivering quality medical care to you, our patient, and to making your visit as pleasant as possible. The following "Statement of Patient Rights" was developed by the Department of Health, Commonwealth of Pennsylvania, and is endorsed by the administration and staff of this healthcare facility. As it is our goal to provide medical care that is effective and considerate, we submit this to you as a statement of our policy. ...14. A patient has the right to appropriate assessment and management of pain."

Review on August 22, 2012, of MR1 revealed the patient presented to the Emergency Department on July 6, 2012, at 10:02 PM with bug bites of the right lower leg and right upper arm. Areas were painful, red, raised and itchy. Documentation noted the patient's pain level was 10/10 on the pain scale. The patient was triaged at 11:47 PM and identified as an Emergency Severity Index Semi-Urgent (Level 4), with treatment and reassessment to be completed in one to two hours.

Further review August 22, 2012, of MR1 revealed documentation at 03:20 AM that the patient left the Emergency Department without being seen by the physician. There was no documentation of treatment and reassessment following the initial triage at 11:47 PM.

Interview with EMP3 on August 22, 2012, at approximately 10:15 AM confirmed that MR1 had no reassessment performed following the initial nursing assessment performed at 11:47 PM.

Interview with EMP1 on August 22, 2012, at approximately 10:00 AM confirmed the turn around times in the Emergency Department were an issue.

Cross reference 482.55(a)(3) Emergency Services Policies

Based on review of facility documents, medical records (MR), and interview with staff (EMP), it was determined that the facility failed to ensure emergency treatment and reassessment was completed as required by facility policy for one of 25 emergency medical records reviewed (MR1).

Findings include:

Review of facility Emergency Department policy, "Triage,"dated revised January 2012, revealed "... Procedure: The Registered Nurse will evaluate and categorize each patient upon arrival to the Emergency Department based upon the standards of the Emergency Severity Index. ... Semi-urgent (Level 4) - treatment and reassessment should occur in one (1) to two (2) hours: Abscess, Constipation, Cystitis, Earache, Minor Bites, Minor Burns, Sore Throat, Sprains/strains, STD's [sexually transmitted disease], Vaginal Discharge. ..."

Review of MR1 on August 22, 2012, revealed the patient presented at the Hazleton General Hospital's Emergency Department on July 6, 2012, at 10:02 PM. The patient was triaged at 11:47 PM. The patient was assigned an Emergency Severity Index (ESI) of Semi-urgent (Level 4). Pain intensity was documented as a 10 on a scale of 1 through 10. Nursing triage documentation at 11:47 PM noted the patient's right lower leg to be red, raised, itchy, and painful. Documentation revealed the complainant was registered at 12:02 AM July 7, 2012, and directed to the waiting room area. There was no further documentation of assessments of the patient's pain, vital signs or the condition of the patient's right lower leg. Further review of MR1 revealed the Emergency Department Registered Nurse went to the waiting area at 3:20 AM on July 7, 2012, and discovered MR1 was no longer in the waiting area.

Interview with EMP1 on August 22, 2012, at approximately 10:00 AM confirmed the turn around times in the Emergency Department were an issue.

Interview with EMP3 on August 22, 2012, at approximately 10:30 AM confirmed the Emergency Department's Triage Policy was not followed and treatment and reassessment were not provided to MR1 within one to two hours.