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Based on interview and record review the facility failed to maintain an accurate Emergency Department (ED) patient log when one patient (Patient 10), who presented to the facility's ED seeking emergency medical treatment, was not included in the ED patient log.

This failure has the potential to result in delayed care and treatment for patients in the ED.

Findings:

On April 4, 2023, at 10:30 a.m., an unannounced visit was conducted at the facility for an EMTALA survey.

On April 4, 2023, at 12:35 p.m., the ED patient log provided by the Director of Quality (DOQ) was reviewed. The ED patient log did not indicate Patient 10 arriving at the ED on April 3, 2023.

On April 4, 2023, at 12:45 p.m., an interview with the Chief Quality Officer (CQO) was conducted. The CQO stated she just learned 10 minutes prior to this interview about a patient (Patient 10) who came to the ED on April 3, 2023, filled out the registration paperwork, and indicated he was hurt at work on March 31, 2023. The CQO stated Patient 10 did not want to file anything with his company yet. The CQO stated when the patient was asked to refill out the form. the patient stated the Registration Clerk (RC) was smiling at him and thought it was funny, became angry, and left the ED. She stated Patient 10 was not put on the ED patient log and should have been. She stated there was no medical record for Patient 10 because he was not registered nor seen at the ED prior to him leaving.

On April 4, 2023, at 1:25 p.m., an interview was conducted with the RC. The RC stated a patient (Patient 10) came to the ED on the morning of April 3, 2023, complaining of ankle pain. The RC stated the patient stated he hurt his ankle at work on Friday March 31, 2023, and it started hurting on April 2, 2023, so he came to the ED on April 3, 2023. The RC stated the patient marked yes on the portion of the patient registration form which asked if he was injured at work. The RC stated he explained to the patient that there was another form he needed to fill out which the doctor who will see him will also fill it out, and then he can give that form to his employer. The RC stated the patient said he did not want to involve his company yet. The RC stated she asked the patient to refill out the form because it was a legal document and will be scanned into his chart, and if it indicated yes he was hurt at work and the proper paperwork was not filled out, then it was an issue. The RC stated the patient stated she was smiling at him and I thought it was funny. The RC stated she tried to explain to the patient that she smiles at everyone and she was friendly. The RC stated the patient became upset and told her to give him his driver's license back and left. The RC stated she did not add Patient 10 on the ED patient log. The RC stated, "I placed his forms in the shred bin."

On April 4, 2023 at 1:45 p.m. an interview was conducted with the Director of Admissions (DOA). The DOA stated Patient 10 was not placed on the ED patient log. The DOA stated Patient 10 should have been recorded on the ED patient log. He stated all patients presenting to the ED should be added to the ED patient log along with their disposition.

On April 4, 2023 at 3:30 p.m., the CQO provided a copy of Patient 10's "Patient Registration Form," which was retrieved from the shred bin. The undated registration form indicated Patient 10 arrived at the ED for right ankle pain at 8:10 a.m. The CQO verified Patient 10 filled out the patient registration form on April 3, 2023.

The facility's policy and procedure titled, "EMTALA," dated February 2023, was reviewed. The policy indicated, "...The hospital will maintain a central log of each individual who comes into the Emergency Department seeking assistance..."