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Based on record review and interviews, the hospital failed to maintain an accurate and complete Emergency Department Central (patient) Log on each individual who came to the Emergency Department as evidenced by failing to document in the central log a patient who presented seeking medical attention for 1 (#1) of 20 (#1-20) patients sampled.

Findings:

Review of the hospital's policy titled "Admission, Discharge, and Transfer Guidelines for the Emergency Department" revealed in part:
III. Policy Statements
A. All persons presenting for care in the ED will receive a basic registration which will include the patients name and date of birth.
IV. Procedures/Standards and Roles & Responsibilities
A. General Procedures
1. The patient information gathered in the basic registration will generate a patient encounter number and populate the patient's medical record.
2. A registration log containing the patient's name, date and time of arrival and chief complaint will be maintained on paper or electronically.

Review of the ED Log for the dates 01/01/2023 through 01/04/2023; Left without being seen between 08/01/2022 through 01/20/2023; and transfer logs between 08/01/2022 through 01/21/2023 failed to reveal Patient #1.

In an interview on 01/25/2023 at 1:17 p.m. S3PA stated when Patient #1 and her parents came in to the emergency department, she obtained Patient #1's name and date of birth and entered the information into the patient lookup box on the computer. S3PA stated a nurse came and spoke with the parents of Patient #1 and then the parents and Patient #1 left the emergency department. S3PA confirmed since Patient #1 left, she clicked cancel in the patient lookup box and Patient #1's name and date of birth was deleted and not entered into the ED log.

Based on record review and interview, the hospital failed to provide a medical screening exam on all patients who presented to the emergency department with an emergency complaint for 1 (#1) of 20 (#1-20) patients sampled. This deficient practice is evidenced by Patient #1 presenting to the emergency department seeking medical treatment, Patient #1's parents speaking with S2RN and then leaving the emergency department without receiving a medical screening exam because S2RN told her the Emergency Department did not have a pediatrician, had no beds available, and a long wait time to be seen.

Findings:

A review of the ED Log for the dates 01/01/2023 through 01/04/2023; Left without being seen logs between 08/01/2022 through 01/20/2023; and transfer logs between 08/01/2022 through 01/21/2023 failed to reveal Patient #1.

In an interview on 01/23/2023 at 1:50 p.m. Patient #1's mother stated her daughter (Patient #1) had blisters, rash, and not moving her neck. Patient #1's mother stated her husband, daughter (Patient #1), and herself arrived between the hours of 11:00 a.m. - 2:00 p.m. on 01/03/2023. Patient #1's mother stated when they arrived to the emergency department, the charge nurse (S2RN) stated the hospital did not have a pediatrician, there was a 3-4 hour wait, and the hospital had no rooms available, so don't bother on waiting. Patient #1's mother stated there were "2 younger gals" at the front desk. Patient #1's mother stated "the gals" at the front desk did not take their name. Patient #1's mother stated no one asked what was wrong with her child. Patient #1's mother stated, "No vitals were done, nothing." Patient #1's mother stated they went to hospital B, where there was no wait and Patient #1 was immediately seen.

In an interview on 01/25/2023 at 1:17 p.m. S3PA stated when Patient #1 and her parents came in to the emergency department, she obtained Patient #1's name and date of birth and entered the information into the patient lookup box on the computer. S3PA stated the nurse came and spoke with the parents of Patient #1 and then the parents and Patient #1 left the emergency department. S3PA confirmed since Patient #1 left, she clicked cancel in the patient lookup box and Patient #1's name and date of birth was deleted and not entered into the ED log.

In an interview on 1/25/2023 at 10:15 a.m. S2RN stated she was the charge nurse on 01/03/2023 and she recalls Patient #1, 2 year old. S2RN said the emergency department was very busy with no empty beds. S2RN said the father was carrying Patient #1 and upon her seeing Patient #1 thought "oh my gosh." S2RN said Patient #1 had an unbelievable rash and blisters all over her body. S2RN specifically remembers her arms and legs being blistered and thought her face may have been as well. S2RN said Patient #1's parents said the rash started 3 days before they came to the ER. While talking to Patient #1's parents Patient #1 lifted her head and looked at her. S2RN told the parents that she did not have a bed, she needed them to take a seat. S2RN then said the father then asked, what do you mean have a seat. She cannot walk, referring to Patient #1. S2RN then directed the father to hold Patient #1 because she did not have a place to put Patient #1. S2RN said the father asked if the hospital had pediatrics and she told him no. S2RN said she told the parents that they were going to get Patient #1's vital signs in a minute. S2RN said while talking to the parents other patients entered the emergency department; therefore she walked to see what their complaints were. S2RN also walked around the waiting room to check on other patients. S2RN said she then went to the back of the emergency department to see if she could move anyone out of a bed. S2RN said at this time there was another patient in triage. S2RN said upon her returning to the lobby, Patient #1 was gone and she could not believe the parents waited so long to bring Patient #1 to the ED. S2RN explained the 5 level triage system and verified that the appropriate level would be assigned after triage and vital signs were completed. S2RN verified that no level was assigned as triage was not completed. When asked if it was possible that after triage and vital signs were obtained Patient #1 may have been the sickest person in the emergency department, S2RN said it was possible. However, she did not think Patient #1 was in any distress. When asked if she obtained a respiratory rate, heart rate or temperature, S2RN stated no, that's usually completed in triage but she did not feel that Patient #1's condition was life threatening. S2RN also confirmed they sometimes place patients in the hallway for treatment.

Review of Patient #1's medical record from hospital B revealed Patient #1 was admitted to hospital B with painful erythematous sloughing rash, febrile illness for further evaluation on 01/03/2023 at 6:09 p.m. Further review revealed a physician's order dated 01/04/2023 at 12:38 p.m. MD to Nurse: transfer to hospital C to the care of S4MD.