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Based on interview and record review, the hospital failed to ensure that the Emergency Department (ED) log was accurate for the following:

1. Incorrect dispositions were recorded for four of 23 sampled ED patients. (Patients 7, 8, 10, and 11) and

2. Two of 23 sampled patients were included on the log did not receive care in the ED. (Patients 5 and 15)

These failures had the potential for miscommunication and the inability to accurately assess the compliance with CFR 489.20- 489.24 requirements.

Findings:

1. On 9/15/14, the ED log, and Patients 7, 8, 10, and 11's records were reviewed. The log contained the following dispositions:

a. Patient 7 presented to the ED on 7/23/14. Patient 7's disposition was listed as home on 7/24/14. Patient 7's record indicated Patient 7 was admitted for observation.

b. Patient 8 presented to the ED on 7/28/14. Patient 8's disposition was listed as transfer to another hospital on 7/29/14. Patient 8's record indicated Patient 8 was admitted for observation.

c. Patient 10 presented to the ED on 8/6/14. Patient 10's disposition was listed as left against medical advice on 8/7/14. Patient 10's record indicated Patient 10 was admitted for observation.

d. Patient 11 presented to the ED on 8/7/14. Patient 11's disposition was listed as left against medical advice on 8/7/14. Patient 11's record indicated Patient 11 was admitted for observation.

On 9/16/14 at 3 pm, Administrative Staff A acknowledged that the ED log did not correctly list the ED disposition for Patients 7, 8, 10, and 11.

2. On 9/15/14, the ED log, and Patients 5 and 15's records were reviewed.

a. Patient 5's record indicated he was admitted for outpatient surgery. Patient 5's record did not contain any evidence of ED care.

b. Patient 15's record indicated that he received a CT scan (computerized tomography - a x-ray of the head). Patient 15's record contained no evidence that Patient 15's received ED care.

On 9/16/14 at 3 pm, Administrative Staff A acknowledged that the ED log contained patients who did not receive ED care.



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