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Tag No.: A2400
Based on review of facility policies and procedures, Personnel Files (PF) and interviews with staff (EMP), it was determined the facility failed to ensure staff were educated on EMTALA for nineteen of twenty Personnel Files reviewed (PF1-PF19).
Findings include:
Review on August 29, 2022 of facility policy EMATALA (Emergency Medical Treatment and Labor Act) Guidelines revised, March 3, 2015 "Purpose: to establish guidelines for the appropriate care and treatment of patients presenting to the Emergency Department consistent with EMTALA guidelines" revealed the facility did not have a policy in place or verifiable documentation to ensure staff education was maintained.
Review on August 29, 2022 of PF's (PF1 through PF19) revealed no documented evidence these employees had EMTALA education/training.
Request on August 30, 2022 at 1:15 PM to EMP2 for verifiable documentation to ensure staff education and training was maintained on EMTALA guidelines. None was provided.
Request on August 30, 2022 at 1:30 PM to EMP2 for facility policy that identifies policy and procedures in place for staff education on EMTALA guidelines. None was provided.
Interview on August 29, 2022 at 10:58 AM with EMP7 revealed no knowledge of EMTALA, with EMP7 stating ... "I do not know what EMTALA stands for or what it means ..."
Interview on August 29, 2022 at 12:30 PM with EMP9 revealed no knowledge of EMTALA, with EMP9 stating... "I do not know what EMTALA means..."
Interview on August 30, 2022 at 10:00 AM with EMP11 revealed no knowledge of EMTALA, with EMP11 stating ... "I do not know what EMTALA is or what it means ..."
Interview on August 30, 2022 at 1:45 PM with EMP12 revealed limited knowledge of EMTALA, with EMP12 stating... "isn't that when they do not have insurance we cannot refuse them..."
Interview on August 30, 2022 at 2:00 PM with EMP13 revealed limited knowledge of EMTALA, with EMP13 stating... "when they do not have insurance we cannot refuse them..."
Email request on September 23, 2022 at 8:55 AM to EMP2 requesting verifiable documentation to ensure staff education and training was maintained for EMTALA guidelines. None was provided.
Email request on September 23, 2022 at 2:17 PM: to EMP2 for facility policy that identifies procedures in place for staff education on EMTALA guidelines. None was provided.
Email confirmation on September 27, 2022 at 3:42 PM from EMP2 for verificable education/training revealed PF's (PF1-PF19) had no documentated evidence of EMTALA education/training.
Tag No.: A2405
Based on review of facility policy, facility documents, medical records (MR) and staff (EMP) interviews, it was determined the facility failed to maintain documented patient registration or final disposition in Emergency Department (ED) central log on 15 of 21 medical records reviewed (MR1, MR2, MR6, MR7, MR9, MR12, MR13, MR14, MR15, MR16, MR17, MR18, MR19, MR20, MR21).
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Findings include:
Review on August 31, 2022 of facility policy EMTALA (Emergency Medical Treatment and Labor Act) revised, March 3, 2015 revealed "Purpose: To establish guidelines for the appropriate care and treatment of patients presenting to the Emergency Department consistent with EMTALA guidelines. Policy: All patients presenting to the Einstein Medical Center Montgomery (EMCM) for a non-scheduled visit and seeking care must be accepted and evaluated regardless of the patient's ability to pay. All patients shall receive a medical screening exam ... Medical Screening Exams: Medical Screening Exams should include at a minimum the following: Emergency Department Log entry including dispostion of patient (Cerner Electronic Log) ..."
Review on August 30, 2022 of facility document "ED Activity Log, ... ED tracking group, Location ... ED all beds" for the Emergency Department patients who came in for treatment from December 1, 2021 at 12:00 AM to August 29, 2022 at 11:59 PM revealed:
Review on September 16, 2022 of MR1 revealed, patient came to the Emergency department seeking treatment on August 20, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR2 revealed, patient came to the Emergency department seeking treatment on August 3, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR6 revealed, patient came to the Emergency department seeking treatment on January 5, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR7 revealed, patient came to the Emergency department seeking treatment on June 14, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR9 revealed, patient came to the Emergency department seeking treatment on January 3, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR12 revealed, patient came to the Emergency department seeking treatment on August 5, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR13 revealed, patient came to the Emergency department seeking treatment on December 17, 2021. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR14 revealed, patient came to the Emergency department seeking treatment on May 26, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR15 revealed, patient came to the Emergency department seeking treatment on June 25, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR16 revealed, patient came to the Emergency department seeking treatment on August 14, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR17 revealed, patient came to the Emergency department seeking treatment on January 6, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR18 revealed, patient came to the Emergency department seeking treatment on May 21, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR19 revealed, patient came to the Emergency department seeking treatment on December 11, 2021. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR20 revealed, patient came to the Emergency department seeking treatment on December 17, 2021. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Review on September 16, 2022 of MR21 revealed, patient came to the Emergency department seeking treatment on May 22, 2022. No documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Email request sent on September 20, 2022 at 1:36 PM to EMP2 for confirmation of no documented visit in facility's emergency department (ED) control log for MR1, MR2, MR6, MR7, MR9, MR12, MR13, MR14, MR15, MR16, MR17, MR18, MR19, MR20 and MR21.
Phone interview on September 20, 2022 at 4:08 PM with EMP2 confirmed no documented visit in facility's emergency department (ED) control log for MR1, MR2, MR6, MR7, MR9, MR12, MR13, MR14, MR15, MR16, MR17, MR18, MR19, MR20 and MR21. Interview further confirmed no documented evidence in facility emergency department (ED) control log of patient registration or final disposition.
Tag No.: A2406
Based on a review of policies and procedures, facility documents, facility signage, medical records (MR) and staff (EMP) interviews, it was determined Einstein Medical Center Montgomery failed to provide a medical screening examination to a patient that presented to the Emergency Department in two of twenty-one medical records (MR2 and MR3).
Findings include:
Review on August 31, 2022 of facility policy EMTALA (Emergency Medical Treatment and Labor Act) revised, March 3, 2015 revealed "Purpose: To establish guidelines for the appropriate care and treatment of patients presenting to the Emergency Department consistent with EMTALA guidelines. Policy: All patients presenting to the Einstein Medical Center Montgomery (EMCM) for a non-scheduled visit and seeking care must be accepted and evaluated regardless of the patient's ability to pay. All patients shall receive a medical screening exam that includes providing all necessary testing and on-call service within the capability of the Hospital to reach a diagnosis. Federal law requires that all necessary definitive treatment will be given to the patient and only maintenance care can be referred to a physician office or clinic. The triage of a patient for managed care contracts without a medical screening exam is not acceptable under COBRA law."
Review on August 29, 2022 of facility signage "Einstein's Code of Conduct" which was posted in the facility's Emergency department and observed during the tour of the Emergency department, no revision date, revealed, "we will not allow: loud, rude or vulgar language, hostile actions, hurting someone... anyone exhibiting these behaviors may be asked to leave..."
Request made to EMP4 on August 31, 2022 at 1:00 PM for Emergency department documentation policy or protocol for patients who leave the emergency department without being seen. None provided and reported unavailable by EMP4.
Review of MR2 on August 31, 2022 revealed patient arrived to the hospital emergency department on August 3, 2022 at 12:11 AM for complaints of having domestic violence living situations, "Pt in Norristown living with aunt and father and states they are mentally abusing him. Pt states he has some days where he is tired of living, but not currently suicidal. Pt has schizophrenia and paranoia ..." Further review revealed patient was triaged at 12:14 AM and escorted out of the hospital without a medical screening exam.
Further review of MR2 on August 31, 2022 revealed no documentation of this patient receiving a medical exam screening from a qualified medical professional ... Further review revealed, no clinical documentation of patient discharge disposition or documentation of reasoning patient was not provided with a medical exam screening.
Review on August 29, 2022 of facility documents "Left without being seen" revealed patient (MR2) left without being seen on August 3, 2022.
Review on August 31, 2022 of incident report confirmed, "patient (MR2) was given a urine cup and asked to go to the bathroom so could give a urine specimen ... the patient does not go into the bathroom, instead he engages another patient who was sitting in a wheelchair waiting near the bathroom ... he then begins pacing around the ED waiting room and aggressively engaging other patients in the waiting room ... the patient continue to carry on ... security officer said to patient, comon man you gotta go ... the man (patient MR2) walked out with officer without incident" .
Interview with EMP1 on August 31, 2022 at 12:12 PM confirmed, "We interviewed the security officer who interacted with the patient (MR2). He works night shift and is not available during the day ... based on the interview the employee reports patient became agitated when staff asked for a urine specimen, patient went down the hall, security went to get him ... patient used foul language and was escorted out of the hospital at 12:40 PM" ... further interview confirmed no medical provider note for patient in MR2, patient escorted out of the hospital 12:40 PM without a medical screening exam.
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Review of MR3 on August 31, 2022 revealed patient arrived to the hospital emergency department via emergency medical services on August 6, 2022 at 7:27 AM with "complaints of punched in face " ... further review revealed, patient triaged on August 6, 2022 at 7:38 AM and escorted out of the hospital's Emergency department without a medical exam screening by a qualified medical professional.
Review on August 30, 2022, at approximately 9:45 AM of emergency room entrance/waiting room surveillance video time stamped August 6, 2022 7:26 AM through 7:34 AM revealed, 7:26 AM PT1 (MR3) enters the emergency room via ambulance stretcher (EMP1 confirmed the patient in the video is PT1 (MR3). 7:27 AM PT1 (MR3) is getting his vital signs taken at the front desk. 7:29 AM PT1 (MR3) heads towards security guard seated at the front desk, PT1 (MR3) appears to be posturing aggressively at the security guard. 7:30 AM, it appears a female nurse is talking to the PT1 (MR3). 7:31 AM another security guard arrives into the frame. 7:32 AM PT1 (MR3) appears to be shouting at the female nurse. 7:32 AM PT1 (MR3) appears to be shouting at patients sitting in the waiting room. 7:33 AM PT1 (MR3) is escorted out of the doors by two security guards.
Review of MR3 on August 31, 2022 revealed nursing note on August 6, 2022 at 7:58 AM revealed, "pt sat down for VS. Pt turned around and looked at the security guard, stating what you looking at?.... pt proceeded to get up and approach the security guard. Pt berated the guard using profanity ... pt threatened violence against the guard ... pt disengaged from the guard after the tech partner redirected ... triage RN stated that he would not be able to stay if he continued with this language and behavior ... pt ignored the RN and continued to use foul language and threaten staff. RN stated the patient would need to leave the ER due to violating the code of conduct. Pt then approached the RN, continue to call RN names and threaten RN ....Pt continued to stare at the nurse as RN explained that patient had to leave or the PD would be called ... Pt was guided toward the exit by security and escorted to the bus stop. PD was called by the RN to report the incident ..."
Interview with EMP1 on August 31, 2022 at 12:30 PM confirmed patient (MR3) did not receive a medical screening exam prior to being escorted out of the hospital's Emergency department the morning of August 6, 2022 .
Tag No.: A2409
Based on review of facility documents, medical record (MR) and staff interview (EMP), it was determined that the facility failed to follow their policy and failed to execute an appropriate transfer to another facility for one of twenty-two medical records reviewed, (MR3).
Findings:
Review on September 22, 2022 of policy " EMTALA (Emergency Medical Treatment and Labor Act) Effective Date: 9/29/2012 revealed, Purpose: To establish guidelines for the appropriate care and treatment of patients presenting to the Emergency Department consistent with EMTALA guidelines. Policy: If a patient is to be transferred for medical necessity the following guidelines must be followed: A physician certification that the risks of transferring the patient are outweighed by the potential benefits. The individuals risks and benefits must be documented and the patient's medical record must support these, or in addition to the following: The receiving hospital must give acceptance in advance. The acceptance must be documented in the medical record; patient give written consent for transfer as evidenced by signature of transfer form;..."
Review of MR3 on August 31, 2022 revelaed, patient returned to the emergency department on August 6, 2022 with complaints of homicidal towards people in general and suicidal, patient triaged at 13:59 and assigned an Emergency Severity Index Acuity Level: 2 Emergent.. patient seen by emergency room physician on August 6, 2022 at 15:23 and seen by a behavioral health physician on August 6, 2022 with a "treatment plan: inpatient pending medical treatment" at 19:33. Further review revealed patient was transferred to an inpatient behavioral health unit on August 9, 2022 at 3:52 PM.
Review of MR3 on August 31, 2022 revealed, there was no documented evidence of a physican order or transfer form for the transfer of the patient to an inpatient behavioral health facility.
Interview with EMP1 on August 31, 2022, at approximately 1:45 PM confirmed there was no Patient Transfer Form or physican order for patient transfer to non-affiliated inpatient behavioral health facility in MR3.