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Based upon medical record review, policy review, document review and interview, the facility did not comply with all the provisions for maintaining a central log and conducting a medical screening exam.

Please reference findings under Tag A 2405 and 2406.

Based on policy review, document review and interview, the facility did not ensure all individuals presenting to the Emergency Department (ED) are entered on the central log for 1 of 21 patients (Patient #1). Not entering a patient in the central log could result in a patient not receiving a medical screening exam.

Findings include:

Review on 03/20/19 of policy "EMTALA" last revised 03/15 indicates that a central log recording of each individual who comes the ED seeking screening or treatment must be retained for a minimum of ten years.

Review on 03/20/19 of the ED log dated 02/24/19 revealed no evidence to indicate Patient #1 presented to the facility.

Review on 03/20/19 of the Facility Adverse Event Reporting document revealed Patient #1 was transported by ambulance to the facility with reported cardiac symptoms on 02/24/19 at 06:00 AM. An electrocardiogram (EKG) was completed by ambulance emergency medical services (EMS) staff. Upon presentation to the facility, a physician assistant (PA) in the ED reviewed the EKG and directed the EMS staff to transport Patient #1 to another hospital for a cardiology consult. Patient #1 was not registered and/or entered on the ED log.

Interview on 03/20/19 at 02:00 PM with Staff (B), Director Emergency Nursing and Staff (Q), Chief Nursing Officer confirmed that Patient #1 presented to the facility for emergency care but was not entered into the central log.

Based on document review, medical record review and interview the hospital did not provide an emergency medical screening examination (MSE) for 1 of 20 patients (Patient #1). A lack of an MSE could result in an emergency medical condition not being identified and treated.

Findings include:

Review on 03/20/19 of the "Rules & Regulations of Medical Staff", last revised 02/27/18 indicates that all patients presenting to the emergency department (ED) will undergo an MSE and if an emergency condition exists, will receive stabilizing treatment within the capability of the facility.

Review on 03/20/19 of the Facility Adverse Event Reporting document revealed Patient #1 was transported by ambulance to the facility with reported cardiac symptoms on 02/24/19 at 06:00 AM. An electrocardiogram (EKG) was completed by ambulance emergency medical services (EMS) staff. Upon presentation to the facility, a physician assistant (PA) in the ED reviewed the EKG and directed the EMS staff to transport Patient #1 to another hospital for a cardiology consult. A medical screening examination was not completed by the PA prior to Patient #1's departure.

Interview with Staff (B), Director Emergency Nursing and Staff (Q), Chief Nursing Officer on 03/20/19 at 02:00 PM confirmed that Patient #1 presented to the hospital for emergency care and a medical screening examination was not completed.