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Based on review of the facility's Emergency Department (ED) Logs, review of facility policy and procedure, review of five (5) of twenty (20) medical records (Patient (P)11, P12A & P12B, P15 and P19), and staff interview, it was determined the facility failed to ensure all entries in the log are complete and accurate.

Findings include:

Facility policy titled, Emergency Care & Transfers of Individuals with Emergency Medical Conditions (EMTALA), effective 4/30/2024, states, " ...Procedure ...4. Each AHS hospital campus shall maintain a central log to track the care provided to each individual who comes to the ED seeking care for a medical condition and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted, and treated, stabilized and transferred, or discharged. ..."

Review of the ED Log for P11 indicated the patient's disposition was "AMA [Against Medical Advice]." P11 presented to the facilities ED on 4/29/24/24 at 6:51 PM with a chief complaint of "Cyst." P11's vital signs were obtained, and lab work completed. At 11:41 PM, the ED note stated, "Husband walked out with patient."

Review of the ED Log for P12A indicated the patient's disposition was "Eloped." P12A presented to the facilities ED on 4/12/24/24 at 1:11 PM with a chief complaint of "Medical Screening Exam." P12A was triaged at 1:22 PM and vital signs were obtained. At 5:56 PM, the ED Notes state, "Patient called several times for [sic] room without response. Patient was called on cell phone and reports that [he/she] left after [his/her] doppler test. Patient was then advised on the importance of staying for results and plan of care. Patient stated, "I'll come at 7 tomorrow."

Review of the ED Log for P12B indicated the patient's disposition was "AMA [Against Medical Advice]." P12B presented to the facilities ED on 4/12/24/24 at 6:59 PM with a chief complaint of "Follow-up." P12B was triaged at 7:25 PM and vital signs were obtained. At 9:49 PM, the ED Nurse Note stated, "Per registrar pt [patient] left."

Review of the ED Log for P15 indicated the patient's disposition was "Eloped." P15 presented to the facilities ED on 8/4/24 at 12:20 AM with a chief complaint of "Drug Overdose." P15 was a minor who was seen by a provider at 12:32 AM. P15 was seen by a psychiatrist who recommended inpatient behavioral health treatment. P15's parents did not agree with the plan and wanted to take P15 home. After discussing with the facilities legal counsel and reviewing the risks and benefits with P15's medical doctors, P15's parents took P15 home.

Review of the ED Log for P19 indicated the patient's disposition was "AMA [Against Medical Advice]." P19 presented to the facilities ED on 7/27/24 at 1:11 PM with a chief complaint of "Chest pain." P19 was seen by a provider at 1:52 PM and had treatment orders placed. When the provider returned to see P19 at 5:10 PM, P19 had left the ED before treatment was complete.

On 10/11/24 at 1:45 PM, during the exit conference, these findings were discussed with S1(Risk Manager), S2(Council, Risk & Litigation), S3(CNO), and S31(CMO).


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