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Based on interviews, medical record review and policy review, the facility failed to comply with (A2406) by failing to provide an appropriate medical screening examination The cumulative effect of this systemic practice resulted in the facility's inability to ensure that all patients presenting to the Emergency Department would receive a medical screening exam. A totall of 20 patient medical records were reviewed.

Based on interview, medical record review and policy review, the facility failed to ensure a timely emergency medical treatment for Patient #17 who presented with abdominal pain. The sample size was 20 patients.

Findings include:

The medical record review for Patient #17 was completed on 10/11/16. The review revealed the patient presented to the emergency department on 07/09/16 at 8:24 PM and was triaged at 8:44 PM with a chief complaint of postoperative pain to her abdomen radiating to her chest, back, and left and right flanks. She reported her pain level as nine on a zero to 10 scale. She reported her gallbladder had been removed two days ago.

The review revealed an emergency department nursing disposition note dated 07/10/16 at 12:04 AM that stated the patient left at 11:38 PM prior to receiving a medical screening examination, and another note stating the patient was discharged at 1:15 AM.

A review of the emergency department's triage algorithm was completed on 10/11/16. The review revealed patients with severe pain (seven or higher on a zero to 10 scale) needing more than one emergency department resource (e.g. the laboratory and/or radiology) should be graded at level two or three on a one to five scale, with one being the highest acuity.

The medical record review revealed the patient was assigned at level four.

On 10/11/16 at 3:48 PM in an interview, Staff B stated the algorithm has nothing to do with a patient's wait time in the emergency department, but does affect their position in the queue.

On 10/11/16 at 3:48 PM in an interview, Staff A confirmed there is no documentation the patient was reassessed while they waited in the waiting area. (To determine whether to reclassify their triage level and place in queue.)

On 07/10/16 at 11:41 AM the patient returned to the emergency department. The medical record review of the visit was completed on 10/11/16. The review revealed a triage note dated 07/10/16 at 11:47 AM that stated she reports her pain persists at nine, and described as worse prior to surgery and additionally is feeling nauseous.

The review revealed the patient was admitted to the hospital with diagnoses of transaminitis and abdominal pain with elevated liver function tests.

On 10/11/16 a review of the facility's Emergency Medical Treatment and Active Labor Act policy was completed. The review revealed severe pain is an indicator of an emergency medical condition. The review did not reveal how frequently and by what means (e.g. interview, physical assessment) pain should be differentiated between severe and non-severe as well as how it should be reassessed to determine if a patient's condition has either worsened to a emergency medical condition or their emergency medical condition has been alleviated.

On 10/11/16 at 3:48 PM in an interview, both Staff A and B stated they did not have a policy for addressing pain in the emergency department. Staff A explained she did not always just use a pain scale to determine whether the pain is severe, but would also assess for grimacing, guarding, and the vital signs for evidence of pain severity.