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Based on record review , interview, and video review, it was determined that the facility failed to perform a triage assessment and record a medical screening examination of a patient (#1) who presented to the ED, experiencing chest pain and an emergency medical condition. (See tag 2406)

Based on record review, interview, and video review, it was determined that the facility failed to perform a triage assessment and record a medical screening examination of a patient (pt #1) who presented to the Emergency Department, experiencing chest pain, and an emergency medical condition. Findings include:

Pt#1 was an 83-year-old male patient coming to the emergency department with a chief complaint of chest pain and shortness of breath. Pt #1 arrived at the facility on 3/15/22 at 1048 hrs while, coincidentally, a separate cardiac arrest situation with another patient was simultaneously occurring in the ED. Staff C, Clinical Manager of the Emergency Department, saw pt #1 in the waiting room at 1058 hrs, did a visual assessment (undocumented) that led Staff C to conclude pt#1 was not in acute distress. Staff C returned to the first cardiac arrest situation and pt #1 was left alone in the waiting room and was not looked at again until 1154 hrs in which pt #1 was found unconscious. The pt was immediately taken into the ED and CPR initiated. The pt was resuscitated and transferred to the Cardiac Catheterization Lab at 1247 hrs, then was admitted to the Intensive Care Unit. The patient expired 10 days later on 3/24/22. According to the Facility's policy titled, "Patient Triage DMC 160" states; "2. All patients presenting to the Emergency Department will be triaged and directed to the appropriate Emergency Department treatment area to assure timely and appropriate level of care is rendered." With regard to the content of a Triage assessment, the same policy goes on to state, "The Triage RN is primarily responsible for assigning an acuity level to patients based on their history and physical assessment findings ... ... ...(including) chief complaint, ESI level, pain assessment et.al." The facility failed to triage the patient in a timely manner and failed to gather objective assessment data to complete the Triage process resulting in a poor patient outcome.