HospitalInspections.org

Based on observation and interview, the facility failed to ensure the posting of a sign specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor, and information indicating whether or not the hospital participates in the Medicaid program under a State plan approved under Title XIX.

Findings:

During the Emergency Room tour at 1:40 PM on 12/07/12, signs specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor, and information indicating whether or not the hospital participates in the Medicaid program under a State plan approved under Title XIX, were not present.

During an interview of the Risk Manager and Emergency Department Nurse Manager on 12/07/12 at 3 PM, they confirmed the finding.

Based on interview and a review of facility documentation, the facility failed to ensure the maintenance of a central log on each individual who comes to the emergency department, seeking assistance, prior to computer registration for 1 of 20 sampled patients (#1).

Findings:

The medical record of patient #1 was reviewed. The patient was triaged at 6:13 PM on 11/26/12. The physician indicated discharge at 2:25 AM on 11/27/12. A nurse documented discharge at 2:40 AM on 11/27/12. A nurse's note by this same nurse at 2:41 AM read, "Pt. to lobby to wait on taxi."

A nurse's note at 3:45 AM on 11/27/12 read, "Pt in lobby. Pt refuses to leave. She wants to see the doctor again. I explained that the doctor had discharged her. The patient was talking on the phone and stated she had a ride."

A nurse's note at 3:50 AM on 11/27/12 read, "The patient states she needed to use the phone because her phone was dead. I showed her the courtesy phone. I asked her did she need me to call her a taxi. She says she was calling one."

A nurse's note on 11/27/12 at 3:55 AM read, "KPD (Kissimmee Police Department) called to inform me that someone was calling 911 from the lobby. Security called. Pt was still on the phone. I informed the patient that the police has called and said she was calling 911. The patient is alert and ambulating well. I asked the patient did she need me to call a taxi. She said that she did not have any money. I called a taxi with authorization from the supervisor. Security with patient until taxi arrives."

During an interview of the Emergency Room Nurse Manager of the Emergency Department on 12/07/12 at 12:05 PM, she stated familiarity with this patient's case. She stated that the patient had been discharged to the lobby and had told someone in the Emergency Room staff that she wanted to be seen again. When the patient was told she needed to re-register to be seen, she declined to proceed along these lines. Then, the patient waited in the lobby until eventual departure.

During an interview of the Risk Manager on 12/07/12 at 1:15 PM, she stated that they did not have any evidence of an entry in the Emergency Room Log regarding patient #1's request to be seen again on 11/27/12, as voiced in the interview by the Nurse Manager of the Emergency Department (see above) after she had been discharged.

During an interview of an Emergency Room Registration Representative on 12/07/12 at 1:51 PM, she stated that when patients present in the Emergency Room, they are asked to complete a specific form, on paper, with basic demographic information. That form is used to enter the presenting individual's information on the computer. She stated that if a presenting individual leaves the Emergency Room prior to the computer entry, the paper form is shredded. She confirmed that with this shredding, the facility would not have any information on hand regarding the presentation.
in such cases.

During an interview of the Risk Manager and Emergency Department Nurse Manager on 12/07/12 at 3 PM, they confirmed the information as presented above.