HospitalInspections.org

Based on record reviews, document reviews, and staff interviews, it was determined the facility failed to provide a
timely medical screening examination (see tag 2408). This failure has the potential to negatively impact all patients
receiving Emergency Care at the facility.

Based on medical record review, document reviews and staff interviews, it was determined the facility failed to provide a medical screening in one (1) out of twenty-seven (27) patients, Patient #1. This failure has the potential to negatively impact all patients receiving care at the facility.

Findings include:

A policy review titled "Triage of Emergency Department Patients", last reviewed 07/2024. The policy states ..."Any person presenting, or on whose behalf a request is made, for an examination or treatment of a medical condition shall be provided for a medical screening examination to determine whether a medical emergency does or does not exist. The hospital shall provide for an appropriate medical screening examination beyond initial triaging, within the capability of the hospital. (Triage is not equivalent to a medical examination). Acuity levels shall be assigned prior to registration procedures and approved protocols shall be instituted as appropriate. Any physician, Advanced Practice Provider, or ED RN may triage emergency or urgent patients and assign them an available bed". Procedure ...Once arrived the triage RN will complete Triage/ Screening History in EMR. While the Adult/Pediatric Assessment can be completed by the triage RN, it is primarily the patient assigned nurses responsibility ...Emergency Severity Index (ESI): ....Level III-Urgent: Moderate risk situations which involve significant complications, disabilities of impairment of bodily functions (i.e. open fracture, acute abdominal pain, severe pain, etc.). Nurse predicts the use of one resource...Level IV-Stable: Conditions considered at low risk for complications (i.e. simple lacerations, cough, etc.) Nurses predict the use of one resource.

A policy review titled "Emergency Medical Treatment and Labor Act (EMTALA)", last reviewed 02/01/2023. The policy states "West Virginia University (WVUH) will comply with the requirements of the Emergency Medical Treatment and Active Labor Act (EMTALA) by ensuring that when an individual comes by him or herself or with another person to WVUH or its premises and a request is made by the individual or on the individual behalf for medical examination or treatment, WVUH or a department thereof will provide for an appropriate Medical Screening Examination within the capability of the WVUH Emergency Department, including ancillary services routinely available to the Emergency Department, to determine whether or not an emergency medical condition exists or, with respect to a pregnant woman having contractions, whether the woman is in labor. If it is determined that the individual has an emergency medical condition, stabilizing treatment will be provided and they will be either admitted, discharged or transferred as appropriate...Medical Screening Examination...."if an individual arrives on WVUH property or its premises and is not technically in the Emergency Department but requests emergency care, he or she will receive a MSE within the capabilities and capacity of WVUH. Movement of the patient to the WVUH Emergency Department is usually necessary for screening. However, common sense and individual judgment shall prevail. Consideration should be given to: 1. Whether WVUH Emergency Department has the personnel and resources necessary to render adequate medical treatment to all existing patients in the Emergency Department and to adequately respond to new patient emergencies that could arrive at any moment".

A medical record review was conducted for Patient #1. The patient was transported to the Emergency Department (ED) via emergency medical services (EMS) ground ambulance following a motorcycle accident on 7/2/24. The record includes a section titled "Patient Event Tracking" which has the following entries:

7/2/24 3:55 p.m. Patient arrived in ED.
7/2/24 5:18p.m. Patient Triage Started.
7/2/24 5:20p.m. ED Provider First Contact.
7/2/24 6:56p.m. Registration Completed.

The record includes an entry titled "ED Primary Provider Note" completed on 7/2/24 at 5:18 p.m. by Emp #5 which includes a section titled "History of Present Illness" which states, in part, "[Patient #1] presents for evaluation after a motorcycle crash. [Patient #1] states [Patient #1] lost control going around a corner, laid the bike down onto the left side. [Patient #1] estimates speed at the time was around twenty-five (25) miles per hour (mph). Patient was helmeted. [Patient #1] does report striking [Patient #1's] head without associated loss of consciousness and presents with a minimal headache. Main complaint consists of left flank, chest, left upper quadrant abdominal pain. [Patient #1] has had no vomiting. [Patient #1] also complains of left ankle pain. Patient does not take anticoagulants, antiplatelet medications."

The record includes an entry titled "Triage Plan" completed on 7/2/24 at 5:28 by Emp #8 which states, in part, "Triage Plan Patient Acuity: 3".

The record contains a document titled "Clay County Ambulance Service'', dated 7/2/24. An entry on this document states, "At receiving facility (At Rec.) 3:55 p.m., transfer care destination 5:34 p.m." A section titled "Narrative" states, in part, "Patient remained in ambulance for a total of one (1) hour thirty (30) minutes while waiting to be let into facility."

An interview was conducted with Emp #9 on 7/08/24 at 3:05 p.m. Emp #9 was asked about the Emergency Department (ED) on 7/2/24. Emp #9 stated, "The provider at that shift has a lot to do with discharges. A lot of patients were waiting for about four (4) or five (5) hours."

A telephone interview was conducted with Emp #5 on 7/9/24 at 12:50p.m. Emp #5 was asked about their interaction with Patient #1. Emp #5 stated, "I wasn't aware that the patient had arrived at the ambulance bay. There had been a string of horrible days in terms of waiting." Emp #5 was asked if ambulances waiting was a common event. Emp #5 stated, "In the past, typically, we get them into the waiting room from the stretcher no matter how busy we are. We have five (5) minutes to move someone."

A telephone interview was conducted with Emp #7 on 7/9/24 at 1:55 p.m. Emp #7 was asked about the events of 7/2/24. Emp #7 stated, "[Facility] is the most unlikely place for this to happen. Usually, patients are brought in and placed in the hallway. I don't know what happened but the volume at [Facility] is low.