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Based on policy review, medical record review, and staff interview, the facility failed to ensure all individuals presenting to this emergency department (ED) were recorded on the central log for one (#23) of 23 patients reviewed.

Findings included:

An interview conducted July 8, 2021, at approximately 10:00 am with the Risk Manager revealed that Patient #23 presented to the Emergency department (ED) (Hospital A- Adventhealth Zephyrhills) on 5/20/2021. A covid screening was completed on Patient #23 at the entrance of the facility. The waiting room was full. Patient #23 asked the screener how long the wait was for someone with chest pain. The screener told the patient the wait time was over four hours. The facility failed to register Patient #23 on the facility's Central ED log on 5/20/21. The ED Screener for the day of the event was not available for interview during the investigation.

Patient #23 left Hospital A on 5//20/2021 and went to Hospital B. Review of the medical record from Hospital B revealed he was diagnosed with non-ST elevated myocardial infarction (NSTEMI).

Review of the policy and procedure titled, "Chest Pain/ Acute Coronary Syndrome," policy # 17030, Effective Date 4/9/2021 revealed "...the patient will be subject to quick registration and triage upon their arrival to the emergency room. Patient presenting with signs and symptoms of acute coronary syndrome are triaged immediately."

Based on policy review, medical record review, and staff interview, the facility failed to ensure all individuals presenting to this emergency department (ED) received a medical screening examination within the capability of the hospitals; emergency department, including ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition existed for one (#23) of 23 patients medical records reviewed.

Findings included:

An interview conducted July 8, 2021, at approximately 10:00 am with the Risk Manager revealed that Patient #23 presented to the Emergency department (ED) (Hospital A- Adventhealth Zephyrhills) on 5/20/2021. A covid screening was completed on Patient #23 at the entrance of the facility. The waiting room was full. Patient #23 asked the screener how long the wait was for someone with chest pain. The screener told the patient the wait time was over four hours. The facility failed to ensure that on 5/20/21 patient #23 received an appropriate medical screening examination to determine whether or not an emergency medical condition existed. This caused a delay in stabilizing treatment and care of the patient.

The ED Screener for the day of the event was not available for interview during the investigation.

Patient #23 left Hospital A on 5/20/2021 and went to Hospital B. Review of the medical record from Hospital B revealed he was diagnosed with non-ST elevated myocardial infarction (NSTEMI).

Review of the policy and procedure titled, "Chest Pain/ Acute Coronary Syndrome," policy # 17030, Effective Date 4/9/2021 revealed "...the patient will be subject to quick registration and triage upon their arrival to the emergency room.

Based on interview and policy, medical record review and procedure review, it was determined the facility failed to implement its policy regarding informed refusal for one (#23) of 23 patients reviewed.

Findings included:

An interview conducted July 8, 2021, at approximately 10:00 am with the Risk Manager revealed that Patient #23 presented to the Emergency department (ED) (Hospital A- Adventhealth Zephyrhills) on 5/20/2021. A covid screening was completed on Patient #23 at the entrance of the facility. The waiting room was full. Patient #23 asked the screener how long the wait was for someone with chest pain. The screener told the patient the wait time was over four hours. The patient was not registered, triaged, and did not receive a medical screening exam at this hospital. The ED Screener for the day of the event was not available for interview during the investigation.

Patient #23 left Hospital A on 5/2/0/2021 and went to Hospital B. Review of the medical record from Hospital B revealed he was diagnosed with non-ST elevated myocardial infarction (NSTEMI).

Review of the policy and procedure titled, "Chest Pain/ Acute Coronary Syndrome," policy # 17030, Effective Date 4/9/2021 revealed "...the patient will be subject to quick registration and triage upon their arrival to the emergency room. Patient presenting with signs and symptoms of acute coronary syndrome are triaged immediately."

Review of the the policy and procedure titled, "Discharge AMA (Against Medical Advice)," Policy # 16553, Effective Date 3/30/2021 revealed:
Procedure:
Staff should attempt to advise the patient regarding the risk of leaving and notify the physician.
If the patient chooses to leave, document the patient ' s intent and request the patient to sign a Discharge against Medical Advice form. If the patient refuses to sign the form, document the refusal in the medical record.
Document the reason, time, mode of transportation, and if accompanied or alone in the Medical Record.

The facility had no medical record for Patient #23, and no documentation that the patient had been informed of the risks of leaving the hospital without receiving a medical screening examination by a qualified medical personnel.