HospitalInspections.org

Summit

Based on random observation, staff interviews, and review of facility policy and procedure, it was determined that the facility failed to ensure that signage indicating the rights of individuals under EMTALA law, is conspicuously posted in areas likely to be seen by individuals requesting emergency care.

Findings include:

Reference: Facility policy, "Emergency Care & Transfers of Individuals with Emergency Medical Conditions (EMTALA)" states, "... 1. When an individual comes to any non-clinical area of the hospital (e.g., lobby, information desk, hallways, elevators, etc.) and states to a member of the hospital staff that he or she needs emergency care or exhibits symptoms of an emergent nature, the hospital staff shall assist the individual to the ED... [Name of facility] will conspicuously post signs in all EDs and in places likely to be noticed by all individuals entering EDs, as well as those individuals waiting for examination and treatment, including at the entrances... ."

1. During a tour of the facility's Main Entrance on 4/5/2021 at 10:20 AM, there was no EMTALA signage observed in the Main Entrance lobby and waiting area.

2. At 10:36 AM, Staff #1 and Staff #2 confirmed that there were no EMTALA signs in the Main Entrance lobby and waiting area.

Summit

Based on random observation, staff interviews, review of facility documents, and review of facility policy and procedure, it was determined that the facility failed to ensure that individual physician names are included on the Emergency Department's list of on-call physicians.

Findings include:

Reference: Facility policy, "Emergency Care & Transfers of Individuals with Emergency Medical Conditions (EMTALA)" states, " ... A list of physicians who are on-call for duty after the initial examination to provide treatment necessary to stabilize an individual with an emergency medical condition will be maintained... ."

1. During a tour of the Emergency Department (ED) on 4/5/2021 at 11:29 AM, the following was revealed:

a. Upon interview at 11:29 AM, Staff #14 stated that all staff had access to the ED physician's on-call list, which was maintained online. Staff #14 stated that he/she prepared a daily physician on-call list each morning and placed it at each of the ED nurse's stations. A request was made to Staff #14 for the physician on-call list for 4/5/2021.

b. Review of the physician on-call list dated 4/5/2021 revealed the following:

(i) Under the specialty labeled "Cardiology," the designated physician on-call was listed as "SMG." Upon interview, Staff #14 confirmed that "SMG" stands for Summit Medical Group.

(ii) Under the specialty labeled "Colorectal," the designated physician on-call was listed as "ACRS." Upon interview, Staff #2 confirmed that "ACRS" stands for Association of Colon and Rectal Surgeons.

(iii) Under the specialty labeled "Neurosurgery," the designated physician on-call was listed as "SMG."

(iv) Under the specialty labeled "Opthalmology," there was no physician on-call listed. The on-call list stated, "No One Listed."

(v) Under the specialty labeled "Spine Call," the designated physician on-call was listed as "ANS." Upon interview, Staff #2 confirmed that "ANS" stands for Atlantic Neurosurgical Specialists.

(vi) Under the specialty labeled "Surgery," the designated physician on-call was listed as "SMG."

2. Staff #2 confirmed the above findings on 4/6/2021 at 12:30 PM and on 4/9/2021 at 2:24 PM.


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3. Review of the physician on-call schedule for December 2020, revealed the following:

a. Under the specialty labeled "Anesthesia," the name of a group was listed on the following dates: 12/1/20, 12/2, 12/3, 12/4, 12/7, 12/8, 12/9, 12/10, 12/11, 12/14, 12/15, 12/16, 12/17, 12/18, 12/21, 12/22, 12/23, 12/24, 12/28, 12/29, 12/30 and 12/31/20.

(i) The group listed was Summit Anesthesia

4. Review of the physician on-call schedule for November 2020, December 2020, January 2021, February 2021 and March 2021, revealed the following:

a. Under the specialty labeled "Neurosurgery," the name of a group was listed on the following dates: 11/27/20, 12/26/20, 1/4/21, 1/8/21, 1/26/21, 2/1/21, 2/19/21, 3/3/21 and 3/23/21.

(i) The group listed was SMG (Summit Medical Group)

5. The above findings were confirmed with Staff #2 and Staff #3.










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Based on a review of the Union Satellite Emergency Department (SED) log entries of 20 patients and interview with administrative staff, it was determined that the SED failed to maintain a central log on each individual who came to the emergency department seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged.

Findings include:

1. An emergency department log entry dated 11/03/20 for Patient #S4 stated that the patient arrived at the SED at 1528 (3:28pm) with a chief complaint of "Fever, Headache, Vomiting." There was no documentation of the patient's disposition in the log.

2. An emergency department log entry dated 11/10/20 for Patient #S18 stated that the patient arrived at the SED at 1817 (6:17pm) with a chief complaint of "Throat pain, Nosal [sic] coingestion [sic], Stomach pain." There was no documentation of the patient's disposition in the log.

3. Administrator #3 agreed with the findings.

A. Based on a review of hospital policies and procedures, the medical record of one (1) of twenty (20) patients who presented to the Satellite Emergency Department, and related documentation it was determined that a patient was not provided a medical screening examination.

Findings include:

Reference #1: Policy and procedure titled, "BEHAVIORAL HEALTH, MANAGEMENT OF THE PATIENT IN THE EMERGENCY DEPARTMENT (ED) Protocol" states, ".....
II. CONTENT
A. Triage
1. The triage nurse will assess the patient upon presentation to the Emergency Department (ED). Any patient assessed to be "at risk" will be placed on observation pending physician evaluation and physician order for observation. The patient assessed "at-risk" will be assigned the appropriate level of observation in the ED by the ED physician. .....
2. "At-risk" will be defined as suspected or known: .....
c) in imminent danger of harm to self, others, or property, or "at-risk" with potential for elopement; ..... . Patients with any one of the above will be considered at-risk. .....
.....
4. Precautions will be initiated by the nursing staff for all patients assessed to be at-risk:
a. Patient is under observation at all times. Physician order must clearly document 1:1 or video-enhanced, shared or continuous observation.
.....
B. Levels of Observation
1. 1:1 Observation
.....
e. Agitated and/or uncooperative behavior
.....
2. Video-enhanced, shared, continuous observation
.....
d. Intoxicated with risk of falls or elopement
.....
D. Medical Evaluation of Behavioral Health Patients
.....
2. Medical Evaluation of Behavioral Health (BH) Patients
Patients who present to the Emergency Department with behavioral health complaints are evaluated by an emergency physician.
....."

Reference #2: Policy and procedure titled, "Emergency Department Scope of Service" states,
"Purpose:
The purpose of this policy is to identify the scope of care within the Union Campus Satellite Emergency Department of an Atlantic Health System (AHS) Facility.
.....
Types of Patients or Departments Served:
Although the Union Campus as a Satellite Emergency Department may provide care and services to all patients, cases more appropriately treated in an acute care hospital Emergency Department include the following:
.....
Patients with altered mental status or under the influence of alcohol or other substances; .....
All ED patients are assessed, receive treatment and medical screening exam based on presenting symptoms, in addition to, ESI (Emergency Severity Index) 5 Level Triage performed by a clinically competent trained triage nurse.
.....
All patients who come to the Union Campus Satellite Emergency Department will receive a medical screening examination by a qualified medical provider before being discharged home or transferred to another facility.
....."

1. Review of the medical record of Patient #O1 revealed:

a. He/She arrived to the SED by ambulance on 12/31/20 at 9:15pm with an "ED Complaint" of "Etoh (ethyl alcohol), foot pain" as documented by a registrar. The "Admission Type" subsection of the "Visit Information" section stated: "Emergent." A "CoVID-19 Exposure Screening" was documented as having been done. There no no evidence in the medical record that the patient was triaged or provided with a medical screening exam.

b. A copy of the ambulance trip sheet stated:
" .....
Ref (Referral) Other Type: Parking Lot
Location: (name of drug store chain) (Springfield)
.....
Receiving: Hospital
Overlook Medical Center at Union SED (Satellite Emergency Department)
Emergency Department
.....
Barriers to Care: Psychologically impaired
.....
Scene Information (:)
Description: Arrived on scene to find patient walking towards the ambulance. SPD (Springfield Police Department) on scene.
.....
Chief Complaint (Category: Intoxicated (ETOH)) [sic] (:)
ETOH
.....
History of Present Illness (:)
SPD requested for the patient to be transported to a hospital for ETOH (ethyl alcohol).
Medical History (:)
Schizophrenia
Obtained from: Patient
.....
Neurological Exam (:)
.....
Neurological Present: Speech slurring
Mental Present: Oriented - Person, Oriented - Place, Oriented - Time, Within Normal Limits
.....
Injury Details (:)
Reason for Encounter: Non-Injury
Drugs / Alcohol: Alcohol
Drug / Alcohol Indicators Present: Patient admits to Alcohol Use. Smell of Alcohol on Breath.
.....
Impression / Diagnosis (:)
Symptoms: Mental / Psych (Psychiatric)
Impression: Poisoning / drug ingestion
.....
Activity (:)
.....
Arriving to ED. Patient vital signs reassessed. Patient care transferred to ED RN, full report given
....."

c. The "Events" section stated:
"ED Arrival at 12/31/20 2115 (9:15pm)
Unit: UNI (Union) Emergency Department
ED Dismissal at 12/31/2020 2118 (9:18pm)"

2. Review of a NARRATIVE FOR SECURITY OFFICER ______ ________ (first and surname of Staff #7) stated:
.....
On Thursday 12-31-2020 at approximately 2105 hours (9:05pm) Union EMS (Emergency Medical Services) brought in ______ _____ (first and surname of Patient #1) because (he/she) called them and asked to bring (him/her) to the Union ED for foot pain. When the ambulance arrived and the EMS brought Mr. _____ (surname of Patient #O1) into the ED. [sic] Mr, [sic] _____ (surname of Patient #1) began yelling and cursing at the staff. Charge Nurse, _______ _________ (first and surname of Staff #6) asked the Union EMS & Security to take Mr. _____ (surname of Patient #O1) back out of the ED.
I responded to the ED and met with Union EMS Staff and observed Mr. _____ (surname of Patient #O1) being belligerent, cursing, and yelling. I asked Mr. _____ (surname of Patient #O1) to calm down and (he/she) continued to yell and curse at myself [sic] and one of the EMS Officers. At this point, Union EMS left Mr. _____ (surname of Patient #O1) in the Ambulance Bay as they left the facility. Charge Nurse, _________ (surname of Staff #6) called the Union Police Department for assistance.
At around 2115, UPD (Union Police Department) Officers ____ and ______ arrived on site. They spoke to Mr. _____ (surname of Patient #O1) who continued to argue and curse. Police Officer ____ said he will call the Ambulance to take Mr. _____ (surname of Patient #1) to another hospital. At around 2135, Union EMS returned and picked up Mr. _____ (surname of Patient #1), whom they took to another facility. Officers ____ and ______ then left the facility. There were no further requirements of Security at this time."

3. There was no evidence that the patient was provided with a medical screening exam.


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B. Based on staff interviews and review of facility policy and procedure, it was determined that the facility failed to ensure that minors who present to the Emergency Department (ED) without their parents, receive a medical screening examination (MSE).

Findings include:

Reference: Facility policy, "Informed Consent and Minor Patients" states, "... 11. Presentation to Emergency Department. When a minor presents to the Emergency Department (ED) without a parent or guardian, the minor must be examined by the ED physician, who will perform an initial assessment to determine the minor's medical treatment needs and whether a parent or guardian must consent in order for examination and treatment to be provided. ... ."

1. During a tour of the ED on 4/5/21 at 11:11 AM, the following was revealed:

a. Upon interview, Staff #12 indicated that he/she was not allowed to register minors in the ED if they were not accompanied by their parents. He/she stated "I'm not allowed to take a minor if they are not with their parents. I don't handle that. The triage nurse would handle that."

b. Upon interview at 11:16 AM, Staff #9 confirmed that MSEs are not conducted on unaccompanied minors presenting to the ED, or minors presenting to the ED with someone other than their parent(s). He/she stated, "We would triage them and bring them into a room, then call their parents. If we cannot reach their parents, then we would contact the social worker and then maybe DYFS (Division of Youth and Family Services) if we are not able to reach the parents. We are unable to treat the patient without the parent's consent. An MSE would not be done until we are able to reach the parents, unless the patient is critical or until a decision is made by DYFS or the social worker."

2. Staff #1, Staff #2, and Staff #3 confirmed the above findings on 4/7/2021 at 2:50 PM.

Based on review of one (1) out of twenty (20) medical records (#O13) and review of facility documents, it was determined that the facility failed to ensure a reasonable registration process for patients seeking treatment that will unduly discourage individuals from remaining for further evaluation.

Findings include:

Reference: Facility policy titled "Emergency Care & Transfer of Individuals with Emergency Medical Condition (EMTALA)" states, "... 3. ED [emergency department] personnel may not delay screening or stabilization services in order to inquire about an individual's method of payment or insurance status and may not seek, or direct an individual to seek, authorization from the individual's insurance company for screening or stabilization services ... will not engage in any actions that discourage individuals from seeking emergency medical care such as by demanding that emergency department patients pay before receiving treatment ..."

1. Review of Medical Record #O13 on 4/7/2020 revealed the following:

a. The patient arrived to the Emergency Department (ED) on 2/26/2021 at 2:24 AM with complaints of Homicidal/Suicidal Ideation's.

b. The patient's full triage was complete at 3:05 AM and he/she received the Medical Screening Exam (MSE) at 2:47 AM.

c. The full registration, including insurance information was complete at 2:26 AM.

d. The patient received a full registration prior to being triaged.

2. The above findings were confirmed by Staff #1, Staff #2, and Staff #3