HospitalInspections.org

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Based on observation, interview and document review, in one (1) of one (1) observation, the Podiatry Staff did not afford a patient their right to personal privacy during examination and medical treatment.

This failure infringes on the patient's basic right to respect, dignity and comfort while in the hospital.

Findings:

Review of Patient A's Medical Record documented that the patient presented to the Emergency Department (ED) on 08/13/15 with redness, swelling and throbbing pain of his right foot. Patient A had visited an Urgent Care Center that morning where he had a callus removed and pus drained, and was referred to the ED for further evaluation and treatment. After Triage at 11:10AM, the patient was assigned to Hallway Stretcher MH03 in District 2. The ED Podiatrist on call performed an Incision and Drainage (I&D) of Patient A's right foot abscess, and recommended admission for further workup and intravenous antibiotics.

During observation of Staff #8 (Podiatrist) on 08/13/15 at 11:40AM, the staff member examined and treated Patient A "parked" in hallway in front of Nurses' Station and directly across from Patient Bays #M8 and #M9. The curtains were open with another patient and family member present in Bay #M8, and no patient assigned to #M9. No privacy screen was observed around Patient A, who was in full view and within hearing distance of the patient / family member in Bay #M8, to afford him privacy during examination, clinical care discussion and treatment. From the far end of the Nurses' Station, this Surveyor clearly overheard the clinical information discussed and visualized the examination and treatment provided to Patient A.

During interview with Staff #6 (Director of Emergency Nursing Services) and Staff #4 (Chief Medical Officer / VP of Medical Affairs) on 08/13/15 at 11:45AM, both confirmed this observation. When asked why, if open patient bays were available, this patient was assigned to the hallway, Staff #6 responded "The patient assignments are based on staffing, district location and patient acuity, so at times, patients may be assigned to a hallway bed even if open bays are available".

The facility's Policy and Procedure titled "Communication of Health Information to Individuals involved in Patient Care", last revised 12/2010, stated "SJH (St. Joseph Hospital) recognizes that health information that is communicated in any form is to be treated as confidential and in a manner that reasonably protects the communication from being intentionally overheard or intercepted by those who do not need to or have a right to know the information. SJH believes that it is the responsibility of each Department, to implement procedures to achieve a reasonable degree of confidentiality within their respective areas and to establish Operating Policies and Procedures that reasonably protect the confidentiality of oral, written and electronic communications."
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Based on record review and interview, the facility failed to document the disposition for triaged patients that left without being seen by a Physician in five (5) out of five (5) patients.

This failure places all Emergency Department patients at risk for poor outcomes.

Findings:

Review of the Medical Record for Patient M, a 16-year-old female, documents that the patient presented to the ED on 03/26/15 at 10:43PM with a complaint of an allergic reaction. The Initial Triage was documented at 10:44PM. Nursing Notes document the patient as having throat irritation, hives all over the body and difficulty breathing. The patient was triaged as "Emergent" Level 2.

A Nursing Note documented on 03/27/15 at 12:08AM states "Went to cubicle to see patient was not there, went out to Waiting Room no response".

The Medical Record also documents "Patient left after Triage, not in Waiting Area" at 1:07AM on 03/27/15 as "Not seen by MD / PA (Medical Doctor / Physician Assistant)".

Review of the Medical Record for Patient L, a 69-year-old female, documents that the patient presented to the ED on 03/21/15 at 7:22PM with a complaint of dizziness. The Initial Triage was documented at 7:23PM. A further Nursing description of the patient's complaint was noted in the Medical Record. The patient was triaged as "Emergent" Level 2.

The Medical Record also documents "Patient left after Triage, not in Waiting Area" at 7:39PM on 03/21/15 as "Not seen by MD / PA (Medical Doctor / Physician Assistant)".

Review of the Medical Record for Patient N, a 22-year-old male, documents that the patient presented to the ED on 04/14/15 at 5:16AM with a complaint of Chest Pain. The Initial Triage was documented at 5:20AM. No further description of the patient's complaint was noted in the record. The patient was triaged as "Urgent" Level 3.

The Medical Record documents "Patient left after Triage, not in Waiting Area" at 5:57AM on 04/14/15 as "Not seen by MD / PA (Medical Doctor / Physician Assistant)". The record lacks documentation or follow up with the patient after they left the ED.

Review of the Medical Record for Patient O, a 37-year-old female, documents that the patient presented to the ED on 04/24/15 at 1:32PM with a complaint of Chest Pain. The Initial Triage was documented at 1:33PM. An EKG was performed at 1:41PM. The patient was triaged as "Urgent" Level 3.

The Medical Record documents at 3:16PM on 04/24/15 "Not seen by MD / PA (Medical Doctor / Physician Assistant)". No further notes noted. The record lacks documentation or follow up with the patient after they left the ED.

Review of the Medical Record for Patient K, a 59-year-old female, documents that the patient presented to the ED on 03/09/15 at 7:31PM with a complaint of Head Injury. The Initial Triage was documented at 7:31PM. The Triage Notes document that the patient had a fall two (2) days prior and now was having vision issues. The Nurse also documented at 7:35PM "The patient Alert and Oriented x 3 (times three), gait slow". The patient was triaged as "Urgent" Level 3.

The Medical Record documents at 9:21PM on 03/09/15 "Not seen by MD / PA (Medical Doctor / Physician Assistant)". No further notes noted. The record lacks documentation or follow up with the patient after they left the ED.

Review of facility's Policy titled "Against Medical Advice" dated 08/2014 revealed on Page 3, under #6 "Elopement", that "Emergency Department Patients who leave without being seen, or who elope after treatment has begun, require an appropriate notation in the Medical Record".

An interview on 08/14/15 at 10:00AM with Staff Members #3 and #6 confirmed that the facility lacks a procedure for prompt follow up with patients that leave the Emergency Department after Triage.