HospitalInspections.org

Based on record review, policy review, document review and interview the Critical Access Hospital (CAH) failed to ensure the emergency department (ED) completed electrocardiogram (EKG) per CAH policy for 6 of 8 patients reviewed (Patient 2, 3, 12, 15, 16, and 19) who presented with chest pain or shortness of breath. The CAH's failure to obtain an EKG in a timely manner has the potential to place patients at risk for unidentified medical needs and deterioration of their condition.

Findings Include:

Review of a CAH policy titled, "Management of Acute Coronary Syndromes (ACS), PC-081" Revised 09/05/23 showed, "To provide an outline for the stratification of patients that present with chest discomfort and the recommendations for treatment by the American College of Cardiology (ACC) and the American Heart Association (AHA). Hospital personnel will obtain an ECG within 5 minutes of arrival with a chief complaint of chest discomfort or symptoms indicative of cardiac ischemia. (Reference 12-Lead Electrocardiogram (ECG) in Lippincott) Physician will interpret the ECG within 10 minutes of arrival with chief complaint of chest discomfort..."

Patient 2

Review of Patient 2's medical record showed Patient 2 presented to the Emergency Department (ED) on 03/21/24 at 2:19 PM with a chief complaint of chest pain, back pain and nausea and discharged home on 03/21/24 at 7:31 PM after Medical Screening Exam (MSE) ruled out Emergency Medical Condition (EMC).

The medical record showed an Electrocardiography (EKG) (an electrical recording of the hearts activity) was interpreted on 03/21/24 at 3:33 PM, 14 minutes after arrival, and not within 10 minutes as required by policy.

Patient 3

Review of Patient 3's medical record showed Patient 3 presented to the ED on 12/15/23 at 6:56 PM with a chief complaint of sharp localized left side chest pain and discharged home on 12/15/23 at 9:01 PM after MSE ruled out EMC.

The medical record showed an Electrocardiography (EKG) (an electrical recording of the hearts activity) was interpreted on 12/15/23 at 9:01 PM, 29 minutes after arrival, and not within 10 minutes as required by policy.

Patient 12

Review of Patient 12's medical record showed Patient 12 presented to the ED on 12/11/23 at 1:08 PM with a chief complaint of shortness of breath and discharged home on 12/11/23 at 4:00 PM after MSE ruled out EMC.

The medical record showed an EKG was interpreted on 12/11/23 at 1:19 PM, 12 minutes after arrival, and not within 10 minutes as required by policy.

Patient 15

Review of Patient 15's medical record showed Patient 15 presented to the ED on 01/07/24 at 11:36 PM with a chief complaint of shortness of breath and Patient 15 was transferred to a higher level of care on 01/08/24 at 6:05 AM after MSE ruled out EMC and patient stabilized within hospital capabilities.

The medical record showed an EKG was interpreted on 01/07/24 at 11:30 PM, 14 minutes after arrival, and not within 10 minutes as required by policy.

Patient 16

Review of Patient 16's medical record showed Patient 16 presented to the ED on 02/13/24 at 6:24 PM with a chief complaint of shortness of breath and discharged home on 02/13/24 at 9:43 PM after MSE ruled out EMC.

The medical record showed an EKG was interpreted on 02/13/24 at 6:43 PM, 19 minutes after arrival, and not within 10 minutes as required by policy.

Patient 19

Review of Patient 19's medical record showed Patient 19 presented to the ED on 03/21/24 at 5:40 PM with a chief complaint of chest pain and discharged home on 03/21/24 at 8:08 PM after MSE ruled out EMC.

The medical record showed an EKG was interpreted on 03/21/24 at 5:57 PM, 17 minutes after arrival, and not within 10 minutes as required by policy.

During an interview on 03/27/24 at 8:53 AM with Staff H, RN stated, " ...ECG times are a work in progress and unsure how often they meet door to ECG times, but hospital would like to meet 5 minute time frame ..."

During an interview on 03/28/24 at 8:00 AM with Staff A, MD stated that, the problem with delayed EKG's is Respiratory Therapy (RT) is called to ED to do EKG and we are waiting on the RT to come perform the EKG.

During an interview on 03/28/24 at 8:38 AM with Staff B, RN stated that, we have standing orders to call RT to do an EKG but we are all capable of obtaining EKG.

During an interview on 03/28/24 at 9:30 AM with Staff I, RT stated that, if a patient comes in with chest pain the staff call us to do the EKG if we are not available, they can do their own.