HospitalInspections.org

Based on observation, interview, and record review, the facility failed to ensure one of 30 sampled patients (Patient 1) was provided emergency services when Patient 1 presented to Hospital 1's Emergency Department (ED), was 40 weeks and 1 day pregnant and in labor. This failure resulted in Patient 1 being diverted to Hospital 2 for emergency services.

Findings:

During a review of Patient 1's "Physician Note" (PN), dated 12/7/21, at 3:50 PM, the PN indicated, "25-year-old Hispanic female. . .currently at 40 weeks and 1 day estimated gestational age (how far along the pregnancy is). . .presented to current medical labor and delivery, and was turned away and told to come to any other hospital. No call was made for an appropriate transfer services. She comes in now contracting (muscles tightening to help push baby out) every 3 minutes lasting about 60 seconds with gross rupture of membranes (amniotic sac surrounding and protecting the fetus) noted and meconium (feces of infant) stained fluid."

During an interview on 12/13/21, at 8:42 AM, with Family Member (FM) 1, FM 1 stated, on 12/7/21, at approximately 1 PM, he and his pregnant fiance' (Patient 1) went to the clinic for a regular check up. He was driving home from the clinic, when Patient 1 noticed there was fluid leaking from between her legs. They were near Hospital 1, and walked in Hospital 1's ED for treatment. FM 1 stated, when they arrived in the ED, a man greeted them wearing scrubs and told them "We're on diversion [the process of rerouting a patient to a different hospital] we're not accepting patients right now." FM 1 stated, he was not told anything else and he was so upset, he left the ED and drove Patient 1 to Hospital 2. FM 1 stated, upon arrival to Hospital 2, staff attended to Patient 1 right away and Patient 1 was admitted.

During an interview on 12/14/21, at 10:35 AM, with Emergency Department Technician (EDT), EDT stated, only pregnant women coming in by ambulance were being diverted to another hospital.

During an interview on 12/14/21, at 10:46 AM, with Clinical Nurse Leader (CNL), CNL stated, the Emergency Medical Services (ambulance) was diverting pregnant women 35 weeks and under for the last four weeks to other hospitals.

During an interview on 12/14/21, at 11:15 AM, with Director of Licensing and Accreditation (DLA), DLA stated, pregnant women that walk into the hospital were not to be diverted.

During an observation and interview, on 12/15/21, at 3:33 PM, with Director of Security (DS), Site Supervisor of Security (SSS), and Quality Nurse (QN), the Emergency Entrance Door surveillance was reviewed for 12/7/21 at 2:30 PM. A pregnant female walked into the ED entrance accompanied by a male. The female was wearing a black shirt, black pants, pink shoes and had a sweater tied around her waist. The male was wearing black shorts, black shirt, and black shoes. The couple was talking to an unknown person in the triage (the assignment of degrees of urgency to decide the order of treatment between patients) area of the ED. The couple was seen exiting the ED at 2:31 PM (less than a minute after arrival). QN stated, the woman was clearly pregnant and was talking to someone in the triage area.

During an interview on 12/15/21 at 4:17 PM, with Patient 1, Patient 1 stated, on 12/7/21, at approximately 2 PM she presented to the ED with her fiancé because her water (membranes) broke on the way home from her doctor's appointment. Patient 1 stated, she was wearing pink shoes, black pants, black shirt and had a sweater tied around her waist because she was embarrassed. Patient 1 stated, her fiancé was wearing black shoes, black bottoms and a black top. Patient 1 stated, when in the emergency room her fiancé told a man wearing scrubs that Patient 1's water had broke and she was going in labor. The man in scrubs told them they should go to another hospital because they didn't have any rooms, were not accepting patients and were on diversion. The man in scrubs named other hospitals they could go to.

During a review of the facility's policy and procedure (P&P) titled "Emergency Care Center Unit Specific Scope of Services" dated 10/21, the P&P indicated, "[Hospital 1] will provide emergency services and care to any person requesting evaluation and treatment for any condition in which the person is in danger of loss of life or limb, serious injury or illness."

During a review of the facility's policy and procedure (P&P) titled "Triage Process in the Emergency Department" dated 10/21, the P&P indicated, "It is the policy of [Hospital 1] that all patients presenting at the ED (Emergency Department) will be triaged to determine the type and urgency of their condition. . .The Triage Nurse assigned to the ED waiting room is responsible for the initial evaluation including chief complaint, a brief history and vital signs to determine the nature and severity of the patient's condition. The Triage Nurse assigns a triage acuity level to each patient based on presentation and resources required. 1) Triage is performed as promptly as possible to assure adequate evaluation of presenting patients. C. OB Patients - 20 Weeks of Gestation or Greater 1. OB patients who are 20 weeks of gestation that present for evaluation of labor or other obstetrical problems will be escorted to Labor and Delivery (L&D) for triage, unless immediate intervention is indicated. In the case that the patient will stay in the ED for treatment, L&D and Neonatal Intensive Care Unit (NICU) will be notified."

Based on interview and record review, the facility failed to follow their policy and procedure for six of 30 sampled patients (Patient 11, Patient 15, Patient 20, Patient 21, Patient 23, and Patient 26) when Medical Screening Examination (MSE) was not completed by the physician within 30 minutes. This resulted in a delay of care.

Findings:

During a review of Patient 11's "ED [Emergency Department] Triage [assignment of degree of urgency]" (EDT), dated 10/25/21, the EDT indicated, Patient 11 was triaged at 10:27 PM and was assigned an ESI [Emergency Severity Index] Level of 3 (Urgent -time to be seen by the physician 30 minutes or less). Patient 11's "Emergency Documentation" (ED), dated 10/26/21, indicated, MSE was completed on 10/26/21, at 12:07 AM (1 hour and 40 minutes) after triage.

During a review of Patient 15's EDT, dated 9/17/21, the EDT indicated, Patient 15 was triaged at 1:09 AM and was assigned an ESI Level of 3. Patient 15's ED, dated 9/17/21, indicated, the MSE was completed on 9/17/21, at 2:28 AM (1 hour and 19 minutes) after triage.

During a review of Patient 20's EDT, dated 11/8/21, the EDT indicated, Patient 20 was triaged at 7:05 PM and was assigned an ESI Level of 3. Patient 20's ED, dated 11/9/21, indicated, the MSE was completed on 11/8/21, at 11:12 PM (4 hours and 7 minutes) after triage.



34401

During a review of Patient 21's EDT, dated 11/29/21, the EDT indicated, Patient 21 was triaged at 12:58 PM and was assigned an ESI Level of 3. Patient 11's ED, dated 11/29/21, indicated an MSE was completed at 1:53 PM (55 minutes) after triage.

During a review of Patient 23's EDT, dated 10/1/21, the EDT indicated, Patient 23 was triaged at 1:27 PM and was assigned an ESI Level of 3. Patient 11's ED, dated 10/1/21, indicated an MSE was completed at 2:30 PM (1 hour and 3 minutes) after triage.

During a review of Patient 26's EDT, dated 12/10/21, the EDT indicated, Patient 26 was triaged at 3:21 PM and was assigned an ESI Level of 3. Patient 11's ED, dated 12/10/21, indicated an MSE was completed at 4:13 PM (52 minutes) after triage.

During a concurrent interview and record review, on 12/15/21, at 1:53 PM, with Quality Nurse (QN), QN reviewed Patient 11, 15, 20, 21, 23, and 26's EDT and ED medical records. QN confirmed Patient 11, 15, 20, 21, 23, and 26 waited greater than 30 minutes to be seen by the physician. QN reviewed the hospital's policy and procedure and confirmed an MSE must be completed by the physician to patients triage with an ESI level of 3.

During a review of the facility's policy and procedure (P&P) titled "Triage Process in the Emergency Department" dated 10/21, the P&P indicated, "1. A patient will assigned a triage category using the ESI IV. The highest level of triage is assigned based on his/her complaint or condition and number or resources required, taking into account the mechanism of injury for trauma patients. . . 2. . . Level Three-Urgent (time to be seen < [less] than 30 minutes). . ."