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Based on review of facility policy, review of Emergency Department (ED) Central Logs, medical record review and interviews, the facility failed to ensure an accurate ED Central Log and failed to provided a medical screening examination for 1 patient (#19) who presented to the ED for evaluation of 21 patients reviewed.

The findings include:

Patient #19 presented to Facility A's ED on 2/28/2024. The patient had a right knee arthroplasty (knee replacement) 9 days prior to arriving at the ED. The patient had been evaluated by her surgeon the same day and an ultrasound was performed to rule out a blood clot. The ultrasound was inconclusive. The patient's provider had sent the patient an electronic media (email) stating she needed to go to a facility and have another ultrasound. The patient arrived at the ED and showed the email to the registration clerk. The registration clerk advised the patient they did not schedule outpatient ultrasounds and the patient's provider was not a credentialed provider at the facility. The registration clerk advised the patient she could be registered as an ED Patient, the provider could see her and make a plan of care. The patient stated she did not want to sign into the ED. The patient was not registered as a patient into the ED, there was no medical record for the patient, and the patient was not listed on the ED central log. On 2/28/2024 at 7:30 PM the patient presented to Facility B where the patient was evaluated, treated.

Cross Refer A-2405 and A-2406

Based on review of a facility investigation, review of Emergency Department (ED) Central Logs and interviews, the facility failed to ensure an accurate ED Central Log for one patient (#19) who presented to the ED for evaluation of 21 patients reviewed.

The findings include:

Patient #19's family contacted the facility on 3/4/2024 and alleged the patient presented to the ED on 2/28/2024 somewhere around 6:00 PM. The patient's primary care physician had told the patient to go to the ED for an ultrasound of the right lower extremity. The son alleged the patient had a 'prescription for an ultrasound' but she was told the ultrasound had to be scheduled and could not be performed. The patient was turned away and not medically evaluated or treated. The patient left the ED and went to Facility B where the patient was evaluated, and an ultrasound was performed. The facility contacted the patent on 3/4/2024. The patient stated her provider had sent her an email and told her to go to a facility to get an ultrasound performed. The patient did not have a written prescription for the procedure but she had an email. She had presented to the facility and showed the admission clerk the email. The registration clerk stated she told the patient ultrasounds were normally scheduled under outpatient status. The admission clerk asked the patient if she wanted to register as a patient into the ED and they could evaluate the patient. The patient stated she did not want to register and left the ED.

Review of the ED Central Logs showed the patient was not listed on the log for 2/28/2024.

During an interview on 4/10/2024 at 1:45 PM, the Director of Quality Management confirmed the patient presented to the ED on 2/28/2024. She confirmed the patient was not registered in the ED and was not placed on the ED Central Logs. The ED admission clerk did not register the patient and did not ask the nursing staff for assistance. The patient left the ED on 2/28/2024.

During an interview on 4/10/2024 at 2:20 PM, the Director of Patient Access stated the patient presented to the ED on 2/28/2024 around 6:00 PM. The Registration Clerk did not register the patient when the patient stated she did not want to sign in. The patient left the ED.

Cross Refer to 2406.

Based on review of facility policy, review of Emergency Department (ED) Central Logs, medical record review and interviews, the facility failed to provide a medical screening examination for 1 patient (#19) who presented to the ED for evaluation of 21 patients reviewed.

The findings include:

Review of facility policy, "Emergency Screening, Stabilization, and Transfer" dated 1/2022, showed "...[A] state and federal regulations, including EMTALA, federal statute 42 CFR 489.24 mandate that whenever an individual comes to the hospital's ED when QMP [qualified medical provider] present, requesting or requiring an examination or treatment, the individual shall receive a medical screening examination [MSE], to determine whether an EMC [emergency medical condition] exits...[B] an EMTALA obligation arises if an individual presents to a [named facility]...campus, [parking lots, including sidewalks, driveways, or within 250 yards of the main hospital entrance] and a request is made by the individual or on the patient's behalf, for evaluation or treatment of the potential EMC...if the individual does not have a medical record, staff open a new medical record for documentation purposes...an MSE is performed on all patients presenting to an ED...requesting or requiring an examination or treatment...if the patient refuses examination and/or treatment, a reasonable effort is made to inform the patient of risks, benefits, alternatives, and consequences of no treatment regarding the offered examination and treatment. The refusal of screening and/or treatment is documented in writing, and if possible signed by the patient or the patient's legal representative..."

Patient #19 presented to Facility A's ED on 2/28/2024 around 6:00 PM, after her primary care physician told the patient to go to the ED for an ultrasound of the right lower extremity. The patient had a right knee replacement in February 2024. The patient had an initial ultrasound earlier on 2/28/2024 which was inconclusive and the patient continued to complain of right leg pain. The patient's surgeon sent the patient an electronic media (email) message to go to the nearest facility and have an ultrasound performed. She presented to Facility A and showed the admission clerk the email. The registration clerk stated she told the patient ultrasounds were normally scheduled under outpatient status. The admission clerk asked the patient if she wanted to register as a patient into the ED and they could evaluate the patient. The patient stated she did not want to register. The patient left the ED. On 2/28/2024 at 7:39 PM, the patient presented to Facility B where she was evaluated and an ultrasound was performed.

Review of Facility A's ED Central Logs showed the patient was not listed on the log for 2/28/2024.

Review of the facility A's Electronic Medical Record showed no record for the patient on 2/28/2024.

Medical record review showed the patient presented to Facility B on 2/28/2024 at 7:43 PM, for an examination related to a possible blood clot.

During an interview on 4/10/2024 at 1:45 PM the Director of Quality Management stated the patient presented the ED admission area at Facility A on 2/28/2024 for evaluation and an ultrasound of the right lower extremity. The patient stated she was told by her primary care physician to go to the ED and get a repeat ultrasound. The patient had an email from her provider which stated she needed an ultrasound of the lower extremity but there was no written order for the procedure. The patient had presented around 6:00 PM, ultrasound staff were not in the facility, and the patient was not scheduled for an ultrasound. The admission clerk told the patient she could not schedule the ultrasound but told the patient she could register into the ED and be evaluated for possible ultrasound if needed. The patient stated she did not want to register into the ED. The ED admission clerk did not register the patient and did not ask the nursing staff for assistance. The patient left the ED on 2/28/2024.

During an interview on 4/10/2024 at 2:20 PM, the Director of Patient Access stated the patient presented to the ED on 2/28/2024 around 6:00 PM. The patient showed the registration clerk an email from her primary care provider which told the patient to go an ED for a radiology examination. The patient told the clerk she needed an ultrasound performed to her right leg. The registration clerk told the patient ultrasounds would have to be scheduled related to the technicians were not in the facility after hours. The registration clerk offered to sign the patient into the ED for evaluation and the ED Physician would make the decision if the ultrasound needed to be performed. The registration clerk again ask the patient if she wanted to sign into the ED. The patient stated she only wanted an ultrasound and did not want to sign in. The patient was given the number to schedule the ultrasound and the patient left the ED. She confirmed if a patient comes to the ED, there should be a 'quick registration' for the patient and a medical record generated for the patient, but this was not done. If there were concerns, the ED Charge Nurse or House Supervisor were available to assist as needed. She stated "...the clerk did not register the patient as the patient stated she did not want to sign in...The house supervisor or the ED triage nurse was not involved with the patient.."

During a telephone interview on 4/10/2024 at 3:20 PM, Registration Clerk #1 stated the patient presented to the ED on 2/28/2024 around 6:00 PM. The outpatient department was closed for the day and there were no orders by a physician for the ultrasound. The patient had an email from her provider which stated the patient needed to go to an ED and have a repeat ultrasound performed. The patient left the ED. Registration Clerk #1 confirmed the patient was not registered and there was no medical record for the patient.

During a telephone interview on 4/11/2024 at 9:15 AM the ED Medical Director stated any patient who presented to the ED for a medical screening should be evaluated and treated by a medical provider.