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Based on record review and interview the facility failed to document a medical screening examination in 14 of 22 (ID #1,2,3,4,5,6,7,8,18, 19, 20, 21,22) patients ED records that were reviewed.

Findings include:

Record review of the facility policy "Medical Screening Exam ED Procedure" (no date), version 6, revealed the following:

Triage does not qualify as appropriate medical screening
Each individual's MSE shall be documented in the electronic medical record.
Record review of the Medical staff Bylaws for Texas Children's Hospital, revised on 11/20/2020, page 10, paragraph 9 stated:
Qualified medical personnel means an individual who are qualified to perform a Medical Screening Examination .... The individual must be a doctor of allopathic or osteopathic authorized to practice in medicine by the Texas Medical Board (TMB). A physician assistant (PA); licensed by the TMB A registered nurse authorized by the Texas Board of Nursing to practice as an advance practice registered nurse (APRN).

Record review of the 14 of 22 (ID#1,2,3,4,5,6,7,8,18, 19, 20, 21,22) medical record revealed, no medical screen exam was documented on the patients that were admitted to the ED.

The medical records revealed all patients (ID# 1,2,3,4,5,6,8,18,19,20,22) were triaged, roomed and assigned a physician, except patient (ID#7), who was triaged, registered and left without being seen, patient (ID#21), was triaged, roomed and registered and left without being seen.

Interview on 11/09/2021 at 1230 with RN, (ID #C) confirmed MSE had not been completed and should be done, and stated the facility was doing a medical screen on patients in the ED that go to urgent care. She also stated RN's are considered secondary QMP and have to be trained to triage and a list was maintained. When questioned, she could not produce the secondary QMP list.

Telephone interview on 11/09/2021 at 1430 with Director of the ED Texas Children's Texas Medical Center, RN, (ID #M) who stated:
The triage nurse can do MSE, and is considered the same as a MSE and meets the definition regarding EMTALA. It is also stated in our bylaws

Interview on 11/09/2021 at 1540 with MD (ID #R), who stated: Triage and MSE are not the same. Patients are triaged, and sorted to find if they high acuity, they are roomed if a bed is available. Every patient gets triaged, they will get a MSE if it appears they can go to urgent care. The family is given the choice to decide if they want to be seen in the ED or urgent care.

Interview on 11/09/2021 at 1605 with MD, (ID #G) who stated the medical screen is completed by the NP as a quick assessment to determine if the patient can go to urgent care.