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Based on record review and interviews, the hospital failed to ensure a medical screening examination was provided to each patient presenting to the ED to determine whether or not an emergency medical condition existed. This deficient practice is evidenced by failing to triage a patient to determine the severity of their illness to decide if the patient needed to be seen immediately for a medical screening exam or could be placed in their car until being seen for 1 (#2) of 20 (#1-#20) patients sampled.
Findings:

Review of the hospital's policy titled "Emergency Medical Treatment and Patient Transfer (EMTALA)" revealed in part: I. Medical Screening Examination - 1. Medical Screening - When a patient comes to the emergency department of the Hospital, or to any location on Hospital property, and a request is made on the patient's behalf for medical examination, within the capabilities of the emergency department (including ancillary routinely available to the emergency department), shall be provided to determine whether an emergency medical condition exists, or with respect to a pregnant woman having contractions, whether the woman is in labor.

Review of the hospital's policy titled "EMTALA-Medical Screening Exam" revealed in part: Medical Screening Examination is the process required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an emergency medical condition exists or a woman is in labor. Such screening must be done within the facility's capability and available personnel, including on-call physicians. The medical screening examination is an ongoing process and the medical records must reflect continued monitoring based on the patient's needs and must continue until the patient is either stabilized or appropriately transferred.

Review of the hospital's COVID-19 Check in Table Log and Screening tool revealed Patient #2 was screened on 08/11/2021 at 6:12 p.m. Further review revealed Patient #2 answered "YES" to the following questions: 1. In the past 14 days have you had a fever or 100.4 or greater? (yes). 2. In the past 14 days, have you had a cough or shortness of breath? (Yes) 3. Have you or anyone in close contact been tested for COVID-19? (Yes) 4. Have you had contact with a person who is COVID-19 positive? (Yes). The log failed to reveal the patient's temperature.
Review of the hospital's emergency department's Daily Log Detail revealed Patient #2 arrived on 08/11/2021 at 6:16 p.m. with a chief complaint of "Fever". Review of the medical record failed to reveal Patient #2 received any form of triage assessment or vital signs to determine the severity of the patient's symptoms. Further review revealed the patient left without being seen at 8:16 p.m.

Review of the hospital's medical records failed to reveal a medical record for Patient #2's 08/11/2021 ED visit. Review of the ED's Daily Log and their COVID Screening Tool Log failed to reveal any temperature, pulse oximetry or any other form of assessment or triage was performed for Patient #2.

Review of hospital staffing schedules dated 08/11/2021 revealed S6RN and S7RN were the only two nurses working in the ED on the day shift when Patient #2 presented to the ED.

In an interview on 08/23/2021 at 9:42 a.m., S5RN stated he remembered Patient #2 and his wife. He said they were at the ED (Emergency Department) before he got there. He said the ED was full of patients. He said S6RN gave him report said the wife wanted to get tested for COVID and Patient#2's problem was malaise and not feeling well. They were instructed by the ED staff to wait in their car if they are positive or symptomatic so they would not expose everybody in the waiting room. S5RN stated the desk clerk told him that Patient #2 and his wife said they were going to leave. S5RN stated he told the clerk to tell them to wait because he wanted to talk to them. S5RN stated he went to the patient's vehicle and spoke with Patient #2 and his wife. S5RN stated Patient #2 and his wife left afterwards. S5RN notified the ED clerk that Patient #2 and his wife had left.

In an interview on 08/23/2021 at 10:55 a.m., S6RN stated she said she was going off shift on 08/11/2021 when Patient #2 and his wife came in to the ED. She said they registered and went to wait in their car and then the oncoming nurse, S5RN, took over. S6RN stated she did not examine or talk to the Patient #2 or his wife.

In an interview on 08/23/2021 at 11:00 a.m., S8ED Director stated if a patient has COVID or symptoms but are not in distress they are asked to sit in their car so as to not infect other patients in the waiting room. S8ED Director continued to state the ED staff would obtain the patient's temperature and pulse oximetry while the patient waits in their vehicle.

In an interview on 08/23/2021 at 2:43 p.m., S7RN stated she was working in the ED on 08/11/2021. She said she did not remember a couple coming into the ED and being sent to their car. She said usually someone will check your pulse oximetry. She said she did not see or speak with Patient #2 or his wife and she said she would have remembered if she did. Registration is the one that tells them to wait in the car.
In an interview on 08/23/2021 at 3:03 p.m., S1Administrator stated it would be appropriate to collect the patient's vital signs before sending them to the wait in their vehicle.

Review of Hospital A's medical records revealed in part: ED Note -08/12/2021 at 1:33 p.m. Patient #2 arrived in ED via Emergency Medical Services vehicle. Per EMS patient was 87-88% per pulse oximetry and was placed on 4 liters oxygen per nasal cannula. ED Triage shows chief complaint of COVID and positive COVID-like symptoms. Acuity 2 (High). Physician Progress 08/12/2021- patient presented to ED for shortness of breath and prior diagnosis of COVID-19. During our interview, patient had a considerable uncontrolled cough. Supplemental oxygen increased from 3 liters to 10 liters. 08/13/2021 - although patient stated he felt better, patient worsened to the point of requiring max Airvo. 08/14/2021 - Patient is intubated and sedated.