HospitalInspections.org

Based on document review and staff interview, it was determined for 7 of 10 patients (Pt #3, Pt #5 thru Pt #10) receiving care in the Emergency Department, the Critical Access Hospital (CAH) failed to ensure a medical doctor (MD) was immediately available to examine patients, potentially affecting all patients receiving care in the Emergency Department (ED).

Findings include:

1. From 09/05/17 to 09/06/17, at various times, the medical records for Pt #3, Pt #5 thru Pt #10 were reviewed. The following information was documented:

Pt #3 - Arrived in the Emergency Department on 09/05/17 at 11:05 PM, with abdominal pain. The ED physician (E #5) examined the patient at 11:55 PM. (More than 30 minutes after arrival) There was no documentation indicating why there was a delay the examination.

Pt #5 - Arrived in the Emergency Department on 07/05/16 at 3:25 AM, with abdominal cramping. E #5 examined the patient at 4:25 AM. (More than 30 minutes after arrival) There was no documentation indicating why there was a delay in the examination.

Pt #6 - Arrived in the Emergency Department on 07/05/16 at 3:25 AM, with abdominal cramping. E #5 examined the patient at 4:25 AM. (More than 30 minutes after arrival) There was no documentation indicating why there was a delay in the examination.

Pt #7 - Arrived in the Emergency Department on 03/28/16 at 11:00 PM, with abdominal pain.
E #5 examined the patient at 11:50 PM. (More than 30 minutes after arrival) There was no documentation indicating why there was a delay in the examination.

Pt #8 - Arrived in the Emergency Department on 03/08/16 at 1:06 PM, with bladder spasms. E #5 examined the patient at 2:02 PM. (More than 30 minutes after arrival) There was no documentation indicating why there was a delay in the examination.

Pt #9 - Arrived in the Emergency Department on 07/26/16 at 12:50 PM, with foot laceration. E #5 examined the patient at 1:45 PM. (More than 30 minutes after arrival) There was no documentation indicating why there was a delay in the examination.

Pt #10 - Arrived in the Emergency Department on 07/25/16 at 12:47 PM. E #5 examined the patient at 1:40 PM. (More than 30 minutes after arrival) There was no documentation indicating why there was a delay in the examination.

2. On 09/06/17 at 11:30 AM, an interview with the Chief Executive Officer (E #1) was conducted. E #1 was aware of the Nursing staff having difficulty, at times, locating the Emergency Department physician (E #5) when he leaves the CAH for short periods of time. E #1 explained that ED physicians may leave the hospital as long as they immediately return when contacted by nursing staff. E #1 confirmed that only a physician was allowed to perform medical screenings in the Emergency Department. E #1 indicated she informed all nursing staff to report to her if they ever have difficulty locating E #5 or E #5 was not responding within a reasonable length of time. E #1 indicated she had not received any complaints about E #5 from the nursing staff in the last 6 months.

3. On 09/05/17 at 9:15 AM, another interview with the Chief Executive Officer (E #1) was conducted. E #1 confirmed that the Emergency Department, physician (E #5) was very hard to wake up when sleeping, and indicated she had made staff aware of the expectation to have Emergency Room patients examined by a physician within 30 minutes upon arrival. E #1 verbalized "The physician is not allowed to give orders over then phone, then wait for the results of those orders, prior to examining the patient." E #1 also indicated there was no hospital policy, just a verbal agreement for the 30 minute time frame.