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Based on review of the Emergency Department (ED) Log and interview, it was determined the facility failed to accurately and completely record two patients who presented to the ED on the ED Log. Failure to enter the patients' name into the ED Log did not allow the facility to track the patients' presentation and treatment. The failed practice affected the two patients and had the likelihood to affect all patients presenting to the ER. Findings follow:

A. In an interview with the Administrator and the Chief Nursing Officer (CNO) on 08/18/22 at 1:35 PM they stated the following:
1) Physician #1 saw any clinic patients that came to the ED after 08/16/22 at 12:00 Noon.
If emergent patients came to the ED, Physician #2 would have been notified.
2) A note was placed on all doors the ED was on diversion, and if an emergency call 911 or go to the nearest facility.
3) A patient came to the ED on 08/17/22 around 2:00 AM. The ED nurse spoke to the patient and told the patient they didn't have a physician onsite. The patient became upset and ran off to the parking lot. The RN saw an ambulance leave with the patient. The patient was not provided a medical screening examination and was not entered in the ER log.

B. In an interview with Registered Nurse (RN) #1 on 08/19/22 at 9:10 AM, she stated the following:
1) RN #1 was working the day shift (7 AM to 7 PM) on 08/16/22.
2) On 08/16/22 at 11:45 AM, Physician #3 received a call and told RN #1 that as of Noon he couldn't work there. There were two patients in the ED when the call was received and an ambulance was on its way to the ED. The ambulance was told the facility was on diversion due to no physician available in the ED. The two patients in the ED were discharged by the physician without a medical screening examination, and were not entered in the ER log.
3) RN #1 contacted the CNO of the situation. The CNO told RN #1 to put signs on the door stating the ED was on diversion and unable to take patients due to no physicians in the ED.
4) RN #1 contacted the local ambulance service and the sheriff's office to let them know they were on diversion and they couldn't take patients regardless of their acuity level.
5) RN #1 stated no other patient were seen the rest of her shift and her shift ended at 7:00 PM.
6) RN #1 stated she put signs on the door that stated due to unforeseen circumstances the facility was on diversion until Thursday.
7) RN #1 stated if a patient presented to the ED they would assist them getting an ambulance if needed one.
8) RN #1 stated she wasn't sure if there were any physicians on call during diversion time frame because she didn't work any of those days.
9) RN #1 stated she heard a patient came to the ED while the ED was on diversion, but not while she was working.

C. Review of the ED Log showed there was no evidence of a patient being placed on the log after 08/16/22 at 10:35 AM. In an interview with the CNO on 08/18/22 at 2:25 PM, the CNO stated she knew of only two patients that came to the ER since 08/16/22 at 12:00 Noon. The CNO stated the patients were not checked in to the system or placed on the ER Log. The CNO stated the patients did not provide names upon learning an ED physician wasn't present the ED.

Based on review of the Izard County Medical Center Rules and Regulations and interview, it was determined the facility failed to follow the Medical Staff Bylaws in that two patients who presented to the Emergency Department (ED) did not have a medical screening exam conducted by a physician or a mid-level practitioner. Failure to provide a timely medical screening exam did not ensure the facility was aware of whether or not the patients had an emergency medical condition, which caused delay in treatment. The failed practice affected the two patients who presented to the ED and did not receive a medical screening exam and had the likelihood to affect all patients presenting to the ED. Findings follow:

A. Review of the Izard County Medical Center Rules and Regulations created on 08/31/17 showed medical screening examinations (MSE) would be performed by a Qualified Medical Provider (QMP). A QMP included a doctor of medicine or osteopathy who was a member of the medical staff or who held clinical privileges approved by the Board of Directors or a physician's assistant, advanced practice registered nurse or midwife functioning within the scope of his or her license and whose clinical privileges had been approved by the Board of Directors.

B. The findings of A were confirmed in an interview with the Administrator on 08/19/22 at 9:00 AM.

C. In an interview with the Administrator and the Chief Nursing Officer (CNO) on 08/18/22 at 1:35 PM they stated the following:
1) The facility underwent a change of ownership effective on 08/15/22 at 12:00 Midnight.
2) On 08/16/22 at 12:00 Noon, the contract with the ED physicians ended.
3) Physician #1 saw any clinic patients that came to the ED after 08/16/22 at 12:00 Noon.
If emergent patients came to the ED, Physician #2 would have been notified.
3) A note was placed on all doors the ED was on diversion, and if an emergency call 911 or go to the nearest facility.
4) A patient came to the ED on 08/17/22 around 2:00 AM. The ED nurse spoke to the patient and told the patient they didn't have a physician onsite. The patient became upset and ran off to the parking lot. The RN saw an ambulance leave with the patient. The patient was not provided a medical screening examination, and was not entered in the ER log.
5) After 08/16/22 at 12:00 Noon, Physician #1 would cover the ED during daytime hours and Physician #2 would cover the nights. The ED did not have on-site physician coverage but had a physician if an emergency came in.
6) A new physician contract went into place on 08/18/22 at 7:00 AM.
7) Family Nurse Practitioner #1 started staffing the ED on 08/18/22 at 7:00 AM.
8) The facility did not have ED on-site physician or mid-level practitioner coverage from 08/16/22 at 12:00 Noon until 08/18/22 at 7:00 AM.

D. In an interview with Registered Nurse (RN) #1 on 08/19/22 at 9:10 AM, she stated the following:
1) RN #1 was working the day shift (7 AM to 7 PM) on 08/16/22.
2) On 08/16/22 at 11:45 AM, Physician #3 received a call and told RN #1 that as of Noon he couldn't work there. There were two patients in the ED when the call was received and an ambulance was on its way to the ED. The ambulance was told the facility was on diversion due to no physician available in the ED. The two patients in the ED were discharged by the physician without a medical screening examination, and were not entered in the ER log.
3) RN #1 contacted the CNO of the situation. The CNO told RN #1 to put signs on the door stating the ED was on diversion and unable to take patients due to no physicians in the ED.
4) RN #1 contacted the local ambulance service and the sheriff's office to let them know they were on diversion and they couldn't take patients regardless of their acuity level.
5) RN #1 stated no other patient were seen the rest of her shift and her shift ended at 7:00 PM.
6) RN #1 stated she put signs on the door that stated due to unforeseen circumstances the facility was on diversion until Thursday.
7) RN #1 stated if a patient presented to the ED they would assist them getting an ambulance if needed one.
8) RN #1 stated she wasn't sure if there were any physicians on call during diversion time frame because she didn't work any of those days.
9) RN #1 stated she heard a patient came to the ED while the ED was on diversion, but not while she was working.

E. Review of the ED Log showed there was no evidence of a patient being placed on the log after 08/16/22 at 10:35 AM. In an interview with the CNO on 08/18/22 at 2:25 PM, the CNO stated she knew of only two patients that came to the ER since 08/16/22 at 12:00 Noon. The CNO stated the patients were not checked in to the system or placed on the ER Log. The CNO stated the patients did not provide names upon learning an ED physician wasn't present the ED.

F. Observation on 08/18/22 at 3:00 PM showed RN #2 and Family Nurse Practitioner #1 was present in the ED.