HospitalInspections.org

Based on review of medical records, documents and staff interview it was determined the facility failed to ensure the posting of signs (see Tag A 2402); failed to keep accurate records of patients presenting to the Emergency Department (ED) in the ED log (see Tag A 2405); and, failed to provide a medical screening exam (see Tag A 2406).

Based on observation and staff interview it was determined the facility failed to post conspicuously in the Emergency Department (ED) signage at the ambulance entrance, main entrance or waiting area specifying the rights of individuals with respect to examination and treatment of emergency medical conditions. Failure to post the required signs has the potential to negatively impact all patients seeking treatment in the ED.

Findings include:

1. A tour was completed of the ED on 12/18/17 at about 11:25 a.m. It was observed there was no signage to notify patients of their individual rights with respect to examination and treatment of emergency medical conditions at the ambulance entrance, the main entrance, or the waiting area of the ED.

2. An interview with the Chief Nursing Officer on 12/18/17 was conducted with regards to the above finding. She agreed there was no signage in these places to notify patients of their rights.

Based on document review and staff interview it was determined the facility failed to record in the Emergency Department (ED) Log one (1) of one (1) patients who presented to the ED for treatment. This patient had no medical records from that time at the facility. Failure to record a patient who presents to the ED for treatment has the potential to negatively impact all patient care provided by the facility.

Findings include:

1. A document review of the 'Official Patient Care Report' from the ambulance service dated 12/4/17 revealed "...a dispatch for a eighty-eight (88) year old female having chest pains...history of pneumonia, coughing, pain and tingling in both arms and some in her abdomen. She has a history of abdominal hernias and pain coincides with locations of present hernias...Patient wishes to be taken to Wetzel County Hospital."

2. Review of documentation from the ambulance service revealed that upon arrival to the facility a nurse and Doctor #1 in the ED informed the ambulance staff "they are not taking patients at this time because their CT is down and they will not be treating our patient." The ambulance documentation further revealed: "They both stated they informed [medcom] we needed to divert and suggested other hospitals that might take patients at this time."

3. A review of the ED log for 12/4/17 revealed the patient's name was not on the log.

4. In an interview with the Chief Nursing Officer on 12/18/17 the above was discussed. She concurred the patient in question had not been logged in the facility ED log.

A. Based on record review, document review and staff interview it was determined the facility failed to enact an appropriate transfer thus causing a delay in the medical screening exam (see Tag A 2408).



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B. Based on document review and staff interview it was determined the facility failed to provide a medical screening exam for one (1) of one (1) patients who presented to the Emergency Department (ED) and requested treatment. The patient had no medical records at the facility nor was she on the ED log. Failure to provide a medical screening exam has the potential to impact all patients who come to the ED and request treatment.

Findings include:

1. A document review of the 'Official Patient Care Report' from the ambulance service dated 12/4/2017 revealed "...a dispatch for a eighty-eight (88) year old female having chest pains...history of pneumonia, coughing, pain and tingling in both arms and some in her abdomen. She has a history of abdominal hernias and pain coincides with locations of present hernias...Patient wishes to be taken to Wetzel County Hospital."

2. Review of documentation from the ambulance service revealed that upon arrival to the facility a nurse and Doctor #1 in the ED informed the ambulance staff "they are not taking patients at this time because their CT is down and they will not be treating our patient." The ambulance documentation further revealed: "They both stated they informed [medcom] we needed to divert and suggested other hospitals that might take patients at this time."

3. In an interview on 12/18/17 at about 2:00 p.m. with the ED nurse, she stated she remembered the above noted incident. She stated the doctor said he couldn't treat the patient due to the Computerized Tomography (CT) scanner not working. She agreed she told the ambulance staff, along with Doctor #1, they would not treat the patient.

4. In an interview with Doctor #1 by telephone on 12/19/17 at about 11:02 a.m. the above findings were discussed. He stated he remembered the incident. He stated they (the facility) got a call about a patient with chest pain and abdominal pain with resolving pneumonia. The CT scanner was not working and there was discussion of the patient's need for a CT scan. He stated, "We could provide an initial evaluation but would just have to send her out to get a CT scan." He stated he was not aware of the diversion policy until the hospital gave it to him yesterday.

5. In an interview with the Chief Nursing Officer and the Nurse Manager of the ED on 12/18/17 at about 1:15 p.m. the above findings were discussed. They agreed the facility did not provide a medical screening exam to the patient when she presented to the ED.

Based on record review, document review and staff interview it was determined the facility failed to maintain a written document explaining to the patient the risk versus benefits of being transferred to another facility by a private owned vehicle. This deficient practice was identified in two (2) of eight (8) transfer records reviewed (patients #3 and 12). This failure has the potential to negatively impact all patients being transferred to another facility by private owned vehicle.

Findings include:

1. Review of the medical record for patient #3 revealed the patient was transferred via private owned vehicle to another facility. Review of the facility document entitled 'Transfer Form' revealed it was left blank in the area related to the risks of transfer and the transportation risks.

2. Review of the medical record for patient #12 revealed the patient was transferred via private owned vehicle to another facility. Review of the facility document entitled 'Transfer Form' revealed it was left blank in the area related to the transportation risks and the risks of transfer.

3. Review of the facility policy entitled "Transfer of Patient to another Facility", last revised 05/15, revealed it states, in part: "...risks and benefits to be documented by Physician and reviewed with patient."

4. In an interview with the Chief Nursing Officer on 12/19/17 at approximately 11:45 p.m. she agreed with the above findings.