HospitalInspections.org

Based on interviews and document review, it was determined the facility failed to provide adequate care and monitoring of patients requiring a higher levels of care.

The findings include:

On 1/10/21 at 11:33 a.m., the Surveyors toured the facility's Emergency Department. The Emergency Department (ED) consists of eighteen (18) beds. There are five (5) beds designated for use as Clinical Decision Unit (CDU) beds that are also used for ED overflow. There is also one (1) decontamination room that is used only for that purpose.

On 1/10/21, the Surveyor conducted a review of the facility's adverse events log. The log revealed an adverse event report submitted on 12/21/2021 regarding a patient being housed in the ED who did not receive the appropriate level of care. Another adverse event report documented a separate event occurring on 10/4/21 about a patient's delay in transfer to a higher level of care due to a delayed physician evaluation.

On 1/11/22 at 10:08 a.m., the Surveyors conducted an interview with Staff Member #13, the Chief Hospitalist, who explained the system at Warren Memorial Hospital (WMH) is such that the Hospitalist is a contracted physician, who are employed by the hospital and are the main physician in charge of the care for the patients assigned.

Staff member #13 states that the ED has had a significant increase in patients, requiring the hospital to use the CDU beds in the ED for overflow and boarding patients in the hallway. Normally patients are admitted to the appropriate unit or transferred to another facility, however "there are no beds anywhere, the situation is national. We do not have enough doctors and nurses. We triage and keep patients if there is nowhere to send them. The situation is shocking."

On 1/11/22 at 2:19 p.m., the Surveyor conducted a phone interview with Staff Member #9, a Nursing Supervisor. Staff Member #9 stated there is a higher acuity of patients coming in to the ED, they are "sicker, and we have to keep them in the ED because there are no beds anywhere." There are rooms designated as CDU but are being used as ED rooms for overflow. Those rooms are equipped with monitors, however the patient placed there also requires a nurse to physically check on them. Staff Member #9 stated, "This is ok if the patient requires that level of care, but there is a higher acuity of the patients coming in. As nurses, we feel concerned about the patients when they normally would be shipped out, but now we keep them and board them in the ED." Staff Member #9 used the example of recently a "dialysis patient" was ill and admitted to the facility even though, "there is no nephrologist here and we don't do dialysis. Since there are no beds anywhere, we take care of them the best we can."

On 1/11/21 at 1:25 p.m., the Surveyor conducted an interview with Staff Member #10, a respiratory therapist. Staff Member #10 stated that patients are being held in the hallway of the ED due to the bed shortage and "are not being assessed like they would be if they were admitted." Staff Member #10 gave the example of recently when in the ED, heard an alarm going off in a patient's room. "Nobody came to check, so I went in and saw the O2 sat (amount of oxygen in the blood-normal range is 95-100 %) was 70 %. Someone took off the bipap (a type of ventilator that helps with breathing) and didn't place the nasal cannula (gives oxygen through a tube placed in the nose) on the patient. Staff Member #10 went on to state the ER nurses, "especially the new ones, are having to keep an eye on patients and take care of the ones that are coming in. Sometimes they all get called away to deal with the emergencies going on, and there is a lack of enough staff to then also handle the patients boarding." The Surveyor asked Staff Member #10 to comment on the statement: is there a failure of the facility to provide adequate monitoring of the patients in this facility? Staff member #10 responded, "yes, that is a fair statement."

On 1/11/21 at 11:15 a.m., the Surveyors conducted an interview with Staff Member #8, Medical Director of the ED. Staff Member #8 stated, there is a volume surge of patients and "not enough staff, no beds available anywhere, no where to send them, so sometimes they are not getting observed." Staff Member #8 also stated there is a "delay in the availability of transport when a bed does become available to send the patient to another facility. We are doing the best we can in this situation."

The Policy, "Plan for Patient Care and Service" under the heading of "Standards of Patient Care: 1. A- The right procedures, treatments, interventions and care will be provided according to the established policies, procedures and protocols that have been developed to ensure patient safety."

Based on interviews and document review, it was determined the facility failed to staff the emergency department with the appropriate numbers and types of professionals to meet the needs anticipated by the facility.

The findings include:

On 1/10/21 at 11:33 a.m., the Surveyors toured the facility's Emergency Department. The Emergency Department (ED) consists of eighteen (18) beds. There are five (5) beds designated for use as Clinical Decision Unit (CDU) beds that are also used for ED overflow. There is also one (1) decontamination room that is used only for that purpose.

On 1/10/21, the Surveyor conducted a review of the facility's adverse events log. The log revealed an adverse event report submitted on 12/21/2021 regarding a patient being housed in the ED who did not receive the appropriate level of care. Another adverse event report documented a separate event occurring on 10/4/21 about a patient's delay in transfer to a higher level of care due to a delayed physician evaluation.

On 1/11/22 at 10:08 a.m., the Surveyors conducted an interview with Staff Member #13, the Chief Hospitalist. Staff member #13 states that the ED has had a significant increase in patients, requiring the hospital to use the CDU beds in the ED for overflow and boarding patients in the hallway. Normally patients are admitted to the appropriate unit or transferred to another facility, however "there are no beds anywhere, the situation is national. We do not have enough doctors and nurses. We triage and keep patients if there is nowhere to send them. The situation is shocking."

On 1/11/22 at 2:19 p.m., the Surveyor conducted a phone interview with Staff Member #9, a Nursing Supervisor. Staff Member #9 stated there is a higher acuity of patients coming in to the ED, they are "sicker, and we have to keep them in the ED because there are no beds anywhere." There are rooms designated as CDU but are being used as ED rooms for overflow. Those rooms are equipped with monitors, however the patient placed there also requires a nurse to physically check on them. Staff Member #9 stated, "This is ok if the patient requires that level of care, but there is a higher acuity of the patients coming in. As nurses, we feel concerned about the patients when they normally would be shipped out, but now we keep them and board them in the ED." Staff Member #9 used the example of recently a "dialysis patient" was ill and admitted to the facility even though, "there is no nephrologist here and we don't do dialysis. Since there are no beds anywhere, we take care of them the best we can."

On 1/11/21 at 1:25 p.m., the Surveyor conducted an interview with Staff Member #10, a respiratory therapist. Staff Member #10 stated that patients are being held in the hallway of the ED due to the bed shortage and "are not being assessed like they would be if they were admitted." Staff Member #10 gave the example of recently when in the ED, heard an alarm going off in a patient's room. "Nobody came to check, so I went in and saw the O2 sat (amount of oxygen in the blood-normal range is 95-100 %) was 70 %. Someone took off the bipap (a type of ventilator that helps with breathing) and didn't place the nasal cannula (gives oxygen through a tube placed in the nose) on the patient. Staff Member #10 went on to state the ER nurses, "especially the new ones, are having to keep an eye on patients and take care of the ones that are coming in. Sometimes they all get called away to deal with the emergencies going on, and there is a lack of enough staff to then also handle the patients boarding." The Surveyor asked Staff Member #10 to comment on the statement: is there a failure of the facility to provide adequate monitoring of the patients in this facility? Staff member #10 responded, "yes, that is a fair statement."

On 1/11/21 at 11:15 a.m., the Surveyors conducted an interview with Staff Member #8, Medical Director of the ED. Staff Member #8 stated, there is a volume surge of patients and "not enough staff, no beds available anywhere, no where to send them, so sometimes they are not getting observed." Staff Member #8 also stated there is a "delay in the availability of transport when a bed does become available to send the patient to another facility. We are doing the best we can in this situation."

The Policy, "Plan for Patient Care and Service" under the heading of "Standards of Patient Care: 1. A- The right procedures, treatments, interventions and care will be provided according to the established policies, procedures and protocols that have been developed to ensure patient safety."