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Based on record review and interview, it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to initiate the triage process in a timely manner for 2 (P-1, 2) of 20 patients reviewed, resulting in the potential for poor patient outcomes. Findings include:

See Tag A-2406: Failure to provide timely triage and medical screening examination

Based on interview and record review, the facility failed to initiate the triage process in a timely manner for 2 of 20 patients (P-1 and P-2) who presented to the Emergency Department (ED), resulting in delayed treatment and the potential for negative outcomes. Findings include:

On 03/24/25 at 1300, during record review the following was noted for P-1:

P-1 was a 65-year-old female with the history of metastatic stage 5 breast cancer. The patient also had a history of hyponatremia. For the past several days the patient had increased confusion, and she was so weak, she could not get up to go to the bathroom. She had been increasingly fatigued, with no urine output in the last 24 hours. She had not been eating and did not consume any type of fluids in the last 2 days. The patient denied any type of fevers, chills or coughing, but she does have chronic nausea. She is also on home oxygen at 3 liters per nasal cannula.

On 03/25/25 at 1200, during review of the document titled "Patient Care Record" (EMS Run sheet) page 1 of 4, revealed:
Patient Arrived at Destination (Date /Time):2025-02-16 at 20:56:14
Destination Patient Transfer (Date/Time): 2025-02-16 at 22:05:00

Review of document titled EMS Patient Care Report revealed, "Patient wanted to be transported to (the facility in question)... Delayed patient turnover due to (the facility of concern) being unable to accept the patient. Patient was taken to room and transferred to bed. Report given to nurse in charge of patient care." Once the patient was triaged, she received an "Emergency Severity Index (ESI)" score of "2" High Risk, Potentially Unstable)".

On 03/24/25 at 1210, during an interview with Staff E, it was confirmed that the patient who came in by EMS was not triaged after arrival for 1 hour and 4 minutes.



P-2
On 3/24/25 at 1400, during review of the medical record for patient #2 (P-2), it was noted that he was a 75-year-old male who was shoveling snow when he developed substernal chest pressure. He stated it lasted 60 to 120 minutes in duration before dissolving. His chest pain did not radiate from his chest. He denied any numbness, tingling, nausea, vomiting, lightheadedness, fever, chills or palpitations.

On 03/25/25 at 1200 during review of the document titled "Patient Care Record" (EMS Run sheet) page 1 of 4, revealed:
Patient Arrived at Destination (Date /Time):2025-02-16 at 2115
Destination Patient Transfer (Date/Time): 2025-02-16 at 2145

Once the patient was triaged, he received an "Emergency Severity Index (ESI)" score of "2" High Risk, Potentially Unstable)".

On 03/24/25 at 1210, during an interview with Staff E, it was confirmed that the patient who came in by EMS was not triaged after arrival for 30 minutes.

On 03/24/25 at 1400, review of facility's policy titled "(Facility Name) Healthcare EMTALA/Physician on Call Policy", policy #15194754, last revised 8/14/2024 revealed:
A. Hospital shall comply with emergency care obligations imposed by the Emergency Medical Treatment and Labor Act (EMTALA). These obligations include the following:

#1. Medical Screening Examination: If a person comes to the hospital and a request is made...for their examination or treatment for a medical condition...then qualified medical personnel will, within hospital's capability and capacity, conduct and document an appropriate medical screening examination reasonably calculated to identify an emergency medical condition...

#8. "No Delay in Examination or Treatment. The hospital will not delay the emergency care described above to inquire about the individual's method of payment or insurance status. Reasonable registration processes may be followed including asking for insurance information if they do not delay or discourage the person from receiving the emergency care described above. Preauthorization will not be sought from insurers or primary care physicians before providing the examination and, where necessary, initiating stabilizing treatment as described above."