HospitalInspections.org

Based on medical record review and interviews, the hospital failed to meet the emergency needs of 1 of 1 patients (patient #1) as evidenced by the failure to reassess the patient's condition prior to discharge in accordance with the emergency department vital sign policy. Upon admission, the patient's heart rate and respirations were outside of the normal range, and not rechecked prior to discharge per policy.

Findings include:
Patient #1 arrived in the emergency room at 7:38 p.m. on 10/20/2009 with flu-like symptoms. She was accompanied by her mother. She was triaged at 7:42 p.m. Employee (H) stated that she did listen to her breath sounds and lung sounds. She noted that her behavior was normal. She did not do vital signs at this time. She was sent to the waiting room, and was placed in a room at 9:48 p.m.

At 9:55 p.m. her vital signs were taken. Her vital signs were: temperature: 100.6, blood pressure: 94/71, pulse: 152, and respiratory rate: 32. Her pulse oxmetry was 90%. Patient #1 was assessed by individual (E)/Physician Assistant who noted her vital signs, and documented that she "did not appear to be in any acute respiratory distress."

Patient #1 was discharged at 10:31 p.m. with instructions to follow up with her physician this week (10/21/2009-10/23/2009) for a recheck, Tylenol every 4-6 hours and Motrin every 6-8 hours, and return to the ER if symptoms worsen. She was not reassessed, and her vital signs were not rechecked prior to discharge.

She saw her primary physician on 10/21/2009 at 11:00 a.m., and was immediately sent to the hospital and admitted with oxygen saturations in the 80's, wheezing, and trouble breathing.

Family member (G) was interviewed on 2/11/2010 at 12:26 p.m. and again on 2/17/2010 at 11:13 a.m. She stated that patient #1 was pale, had a "raspy cough," and was having a hard time breathing upon arrival to the emergency room. The patient sat on her lap the whole time in the emergency room, and stated that staff did not recheck patient #1's vital signs prior to discharge.

The Emergency Department Vital Signs- <18 years of age policy documents that "upon arrival to the Emergency Trauma Center, each patient will have a set of vital signs completed to include blood pressure, pulse, respirations, and temperature... if any of the above are out of approved ranges, than it must be be repeated prior to discharge or transfer."

The approved ranges for a 3-6 year old per the <18 years of age policy are: respiratory rate: 22-34, heart rate: 80-140, and systolic blood pressure 80-100.