HospitalInspections.org

Based on medical record review and interview, the hospital failed to provide an appropriate medical screening examination to an individual who came into the emergency department, in that, 1 of 1 patient (Patient #1) came to the emergency department on 6/28/2016, waited 9 hours to be seen by a physician for a medical screening examination and left without being seen.

Findings included:

Review of the medical record for Patient #1, "35 years old with a history of essential hypertension, diabetes mellitus, type II, uncontrolled, hyperlipidemia, liver masses, adnexal mass, came to the emergency department on 6/28/2016 at 12:53 PM with shortness of breath, midsternal chest pain, and dizziness for 2+ weeks. Patient #1 was triaged including an EKG. EKG results...Sinus tachycardia, cannot rule out anterior infarct, age undetermined, abnormal EKG... 1302...Pulse 110; Resp Rate 20; BP 104/71; lying ...SpO2 100%...Pain 10"...The patient was transferred to the Waiting Room. The patient did not have a medical screening exam and was not examined by a physician. On 6/28/2016 at 9:55 PM, the patient went to the desk and informed them that she was leaving. On 6/28/2016 at 11:07 PM," Patient #1 was found in her car in the parking lot by Dallas County Hospital Police with the car running. The Rapid Assessment Team was called by the officer and she was transferred back to the ED. The patient decompensated in the emergency room, coded and was resuscitated 8 times, but died on 6/29/2016 from an extensive pulmonary embolus."

Review of the hospital's "Triage Walk Back Guidelines" policy on 9/29/2016 at 4:00 P. M. stated, "outline the identification of patients who meet criteria for rapid physician evaluation...Patients needing a rapid physician evaluation include: A. Patients needing an EKG...Age 35 or greater with Chest Pain...Diabetes Mellitus and shortness of breath...with dizziness...cardiac history...B. Triage criteria: Tachycardia with a sustained heart rate > 120...Blood pressure < 100 systolic and/or > 130 diastolic ...C. Nursing judgement...identified need...based on appearance, pain, or distress..."
According to the medical record reviewed on 9/29/2016 at 4:00 P. M., Patient #1 met the criteria for a "Triage Walk Back" for rapid physician evaluation upon triage with the EKG being abnormal, age 35 with chest pain, diabetes mellitus and shortness of breath with dizziness. However, the patient waited 9 hours and did not receive a medical screening examination.
An interview with Personnel #10 was held in the Quality Department on 10/3/2016 at 12:45 P.M. Personnel #10 came on duty at 11:00 P. M. on 6/28/2016. He treated the Patient #1 when she was brought back into the emergency room from the parking garage. He stated that he reviewed the visit that Patient #1 had earlier in the day. He stated there were subtle findings of a pulmonary embolism on the first EKG performed on 6/28/2016 at 1:02 P. M.