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Based on interview and record review, the facility failed to comply with the requirements at 42 CFR 489.24 and 42 CFR 489.20.

Findings included:

The facility failed to have adequate Emergency Medical Treatment and Labor Act (EMTALA) signage, as required by 42 CFR 489.20(q) (see citation at A-2402).

The facility failed to provide stabilizing treatment, as ordered by the provider, as required by 42 CFR 489.24(d) (see citation at A-2407).

Based on observation, interview, and facility policy review, the facility failed to conspicuously post signage specifying the rights of individuals under the Emergency Medical Treatment and Labor Act (EMTALA) in a place or places likely to be noticed by all individuals for 2 of 2 hospital campuses reviewed for EMTALA.

Findings included:

A facility policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)" dated 08/10/2023, revealed, "Signage: [Facility name] will maintain appropriate signage to notify patients of their rights when presenting with emergency conditions and woman in labor, who present to the hospital for care and treatment."

During a facility tour of the Minneapolis emergency department on 06/25/2024 at 11:05 AM, the facility failed to have EMTALA signage posted in the main areas of the emergency department that would be visible to individuals seeking medical treatment at the facility.

During a tour of the Saint Paul emergency department on 06/27/2024 at 1:36 PM, the facility failed to have EMTALA signage posted in the Emergency Department (ED) waiting room.

During an interview on 06/25/2024 at 12:02 PM, Senior Director Compliance Officer #1, stated they thought signage in the emergency department entrance was sufficient.

The facility policy Emergency Medical Treatment and Active Labor Act dated 8/10/23 directed Children's will maintain appropriate signage to notify patients of their rights when presenting with emergency conditions and women in labor, who present to the hospital for care and treatment.

Based on interview and record review, the facility failed to provide stabilizing treatment per the providers orders for 1 (Patient #8) of 21 patients reviewed for Emergency Medical Treatment and Active Labor Act (EMTALA).

Findings included:

A "Face Sheet" revealed the facility registered Patient #8 on 04/01/2024 at 4:18 PM with the symptom/diagnosis of vomiting.

An "ED [Emergency Department] Report - House Staff" document revealed Patient #8 presented to the emergency department with a chief complaint of vomiting. The report revealed the date and time of the evaluation was 04/01/2024 at 5:55 PM. The report indicated the ED course plan was to check the patient's renal function and glucose levels, and to provide stabilizing treatment that included fluids and an anti-emetic. The report revealed the "Plan" section indicated the patient and family left against medical advice before the workup could be completed. The report was electronically signed by the provider on 04/01/2024 at 8:16 PM.

Patient #8's "Orders" sheet revealed an order for sodium chloride 0.9 percent (%) normal saline bolus "Give 110 mL [milliliter] IV [intravenous] once, bag, STAT [statim; immediately]" with an order start date/time of 04/01/2024 at 6:39 PM. The Orders sheet revealed an order for ondansetron (anti-emetic) "Give 1.5 mg [milligram] = 0.75 ml IV push once" to infuse over five minutes STAT with an order start date/time of 04/01/2024 at 6:47 PM. The Order sheet revealed an order for a Basic Metabolic Panel (BMP) to be drawn by the nurse "ASAP [as soon as possible]" with an order start date/time of 04/01/2024 at 6:40 PM.

Patient #8's "ED Discharge Assessment" revealed a note dated 04/01/2024 at 8:15 PM that indicated the patient had left before treatment was completed. The note revealed, "pt [patient] LBTC [left before treatment completed] @ [at] 2001 [8:01 PM], RN [registered nurse] got back from transferring another pt to find empty room."

During a telephone interview on 06/27/2024 at 11:05 AM, RN #15 stated that STAT medications were to be given right away and that if a nurse were with another patient, another nurse would then give the STAT medication. She reported generally that was done within 15 minutes or so with exceptions such as if there was a delay obtaining the medication from the pharmacy or difficulty obtaining IV access. She said that if STAT fluids were ordered, they were available on the floor, and nursing staff would not have to wait for the pharmacy to verify the order prior to administering.

During a telephone interview on 06/27/2024 at 2:37 PM, RN #16 stated the expectation for STAT medications was for them to be given within 15 to 30 minutes but that could depend on circumstances such as if there was difficulty obtaining IV access, if the medication was not in the medication storage and dispensing device and nursing staff had to wait for the medication to come from the pharmacy, or if the patient were off the unit for imaging orders. She also reported that nursing staff would not wait on pharmacy verification to administer STAT IV fluid orders.

During an interview on 06/28/2024 at 10:32 AM, Medical Doctor (MD) #20, stated that when STAT orders were placed the hope was that they would be given as soon as possible but said that it would be hard to give an exact expected guideline for administration timeframes because there could be other things such as trauma going on in the ED.

During an interview on 06/28/2024 at 9:05 AM, Pharmacy Clinical Coordinator (PCC) #11 stated the facility's medication administration policy did not outline timeframes for the administration of STAT medications. PCC #11 said for ASAP and STAT orders they would drop everything and get the medication to the patient as quickly as possible.

The facility policy Emergency Medical Treatment and Active Labor Act dated 8/10/23 directed if the patient is determined to have an emergency medical condition, necessary stabilizing treatment will be provided.