HospitalInspections.org

Based on interview and record review the facility failed to provide a physician on-call list.

Findings include:

On the morning of 9/17/18, in the facility conference room, the surveyor requested a Physician on-call list.

On the afternoon of 9/17/18, the facility presented a list of the ED, and hospitalist schedules for the month of September. The provided documents did not reflect a list of the on-call physician for obstetrics.

Based on interview and record review the facility failed to provide a centralized log for patients presenting to the emergency room as evidenced by not registering Patient #3's visit.

Finding included:

Review of the facility provided Emergency Room Log reflected there was no entry made for Patient #3. Patient #3 had presented on 9/6/18 at 2:00 am with a complaint of contractions and being 41- weeks' gestation for her first pregnancy.

Review of a facility provided typed statement from Staff #5, Labor and Delivery nurse (undated) reflected, "The patient in question presented to the ER complaining of contractions on 09/06/2018 at around 0230.... It was my intention to relay all information to any patient that came in for L&D so that they could make an informed decision before registering."

Review of the facility provided policy EMERGENCY DEPARTMENT PATIENT REGISTRATION (dated 12/05/2016) reflected, "All patients will have the appropriate demographic information obtained by the Admitting Department Clerk. Demographic information will be entered into the computer and a patient chart will be created. ... Patients presenting greater than 20 weeks' gestation will be seen by Labor and Delivery nurse .... All Emergency Department patient information will be maintained in a central log ..."

During an interview on the morning of 9/17/18, in the facility's conference room, Staff #11, Chief Nursing Officer confirmed the finding.

Based on interview and record review the facility did not provide an emergency medical screen when Patient #3 presented to the ED requesting to be seen and was discouraged from staying.

Findings Include:

During a telephone interview on the afternoon of 9/17/18, in the facility conference room, Patient #3 stated, "My prenatal.... I saw him on Tuesday (9/4/18), he said if I didn't have the baby before Thursday (9/6/18) to come in at 7:00 am and he would induce labor. On Wednesday (9/5/18) at 11:00 pm my water broke. I had contractions off and on, at around 2:00 am the contractions were coming every 5 minutes. My mother said we better go. When I came in there was a lady at the front (registrar), she said we can't take you in, we are on diversion.... She asked if I wanted to talk to a nurse.... The nurse said we can't admit you. You have to go to Amarillo. I asked could I be checked to see if I'm dilated ... She said, she would be the one checking me and that it would take one to one and half-hours.... If she checked me I would have to go by ambulance.... I better go right now. She said the Doctor's office should have told me there was no surgeon. I started crying, I was scared, this was my first baby.... She said, 'you better hurry'.... I felt like she wanted to get rid of me...."

Review of the facility provided, Patient #3's Antepartum medical records, reflected a 32 year-old female G1 P0 (gravitas 1 pregnancy 0) with an EDD (estimated date of delivery) of 09/03/2018.

During a telephone interview in the afternoon of 9/17/18, in the facility conference room, Staff #5, RN, Labor and Delivery nurse confirmed a medical screening exam was not conducted.