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Based on staff interviews, review of the Emergency Department's Log (ED log), and hospital's policy and procedures, the facility failed to follow their ED policies when the ED log was not maintained for one of 20 Patients (Patient 1) when presented to the Emergency Department via ambulance and transferred to another facility, and transfer documents for one of 20 Patients (Patient 2) were not located in the medical record, and, the ED did not track the incidents of patient leaving without being seen by a physician and leaving against medical advice. This failure resulted in the inability of the facility to track the patient's care.


Findings:

During an interview on 3/18/21, at 11:24 a.m., Registered Nurse (RN) B, stated the ambulance arrived at the facility on 2/23/21, (RN B did not state a time) with Patient 1 inside the ambulance.

During an interview on 3/18/21 at 11:44 a.m., Staff C stated she was aware the ambulance was coming to the ED. Staff C stated she asked the paramedics/EMT, (emergency medical technician, also known as an ambulance technician) while they were in the ambulance bay, for Patient 1's name and date of birth so she could start the registration process, however, the paramedics did not provide Patient 1's information.

During a record review on 3/18/21, at 12:03 p.m., the facility's Central Log did not indicate Patient 1 arrived in the Emergency Department via ambulance on 2/23/21.

During a Central Log Listing review on 3/18/21, at 2 p.m., Sample Patient 2's medical record did not contain a transfer document or treatment summary when transferred to another facility on 3/10/21 for a higher level of care.

During a Central Log review on 3/19/21, at 11:15 a.m., Sampled Patients were selected based on the following criteria: individual who left without being seen, left against medical advice, transferred to other facilities, refused examination/treatment/transfer, and returned to the emergency department within 48 hours. The Central Log did not have any gaps or non-sequential entries.

During an interview on 3/19/21, at 12:08 p.m., Staff C stated she did not put Patient 1 in the Central Log because Patient 1 was not registered when the paramedics did not provide Patient 1's name and date of birth.

During an interview on 3/23/21, at 11:12 a.m., regarding review of the Central Log, RN F stated the clerk had not been reporting to him the number of patients who left without being seen and who left against medical advice. RN F stated there was no performance improvement process implemented because they were not tracking the incidents of patients not being seen or leaving against medical advice.

Review of the facility's policy and procedure on 3/18/21, titled, "EMTALA- Medical Screening Examination (MSE) and Stabilization," dated 6/5/19, indicated, "The hospital will maintain a Central Log in accordance with the Central Log Policy to record the names and disposition of the individuals presenting to the Dedicated Emergency Department seeking or in need of examination or treatment for a medical condition or elsewhere on the Hospital Property seeking or in need of examination or treatment for a possible Emergency Medical Condition."

Review of the facility's policy and procedure titled, "EMTALA - Patient Transfer," dated 9/25/19, indicated the hospital will send medical records to the receiving facility that contains: the physicians explanation of risks and benefits of the transfer; mode of transport; receiving facility acceptance of the transfer; and individual or legal representative's signed consent to the transfer.

Review of the facility's policy and procedure on 3/2/21, titled, "EMTALA- Patient LWBS, Elopement, AMA, LABS," dated 9/25/19, indicated the numbers of incidents of patient leaving any time after arrival/registration prior to Medical Screening Examination (LWBS), elopement or leaving AMA will be tracked and trended by Emergency Department Manager to determine if performance improvement process should be implemented."

Review of the facility's policy and procedure on 3/24/21, titled, "EMTALA- Central Log" dated 6/5/19, indicated, "A Central Log should be made at the first point of contact. This would normally take place at Triage and be finalized after the medical screening and/or any necessary treatment and Stabilization to address the Emergency Medical Condition. An individual should be recorded in the Central Log even if he/she leaves the hospital before Triage or receiving a Medical Screening Examination."









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