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Based on a review of Emergency Medical Services Documents, Emergency Department (ED) logs,Obstetrics (OB) Logs, Medical Records, Medical Staff Bylaws, Medical Staff Rules and Regulations and staff interviews, it was determined the facility failed to ensure one patient (#20) of 21 patient charts reviewed was entered into the Peri-Natal log after presenting to the department, refer to A2405 and was not provided a Medical Screening Examination (MSE), refer to A2406.

Based on interview, record review, and policy review, the facility failed to ensure one patient (#20) of 21 patients reviewed was entered into the central log (a record of each individual who presents for care). This failure increased the risk of substandard care for all patients entering the Obstetric (OB, the branch of medicine and surgery concerned with childbirth and the care of the women giving birth) Department. The OB average daily census was 12, the average monthly census was 360, and the total transfers were 17 for April through September of 2014. The facility census was 55.

Findings included:

Record review of the facility policy titled, "EMTALA - Central Log," approved on 06/24/14, showed direction for facility staff to maintain a central log on each individual who came into the Emergency Department (ED). This included individuals that came by a ground, non-facility owned ambulance on facility property for presentation for examination and treatment for a medical condition at the facility's dedicated ED.

During an interview on 10/14/14 at 2:40 PM, Staff C, Accreditation, Patient Safety, Risk Manager, stated the ED and the OB logs were separate. The patients over 20 weeks along in pregnancy would present to OB and staff documented them on the OB log.

Record review of the facility's OB log showed no evidence of Patient #20 in the log.

During an interview on 10/15/14 at 1:00 PM, Staff L, Director of Peri-Natal (all OB areas), stated that Patient #20 was not in the log because Staff P, Registered Nurse (RN), believed she did not accept the patient.

During an interview on 10/15/14 at approximately 4:30 PM, Staff C stated that staff failed to log Patient #20 in the OB log.

During a phone interview on 10/21/14 at approximately 7:30 PM, Staff CC, OB Technician, stated that she was relieving the Unit Secretary for lunch when Patient #20 presented to OB per stretcher with Emergency Medical Services (EMS) staff. Typically, a patient ambulated into the OB area, she entered patient information into the computer, and then she escorted the patient to a triage (exam area) bed. When EMS arrived, she was unsure of what she should do and Staff CC notified the Clinical Team Manager (CTM, charge nurse). The EMS staff left with the patient and she failed to enter patient information into the computer OB log.

Based on interview, record review, and policy review the facility failed to provide a Medical Screening Exam (MSE) for one patient (#20) of 21 patients who presented to the Emergency Department (ED) or the Obstetric (OB, the branch of medicine and surgery concerned with the childbirth and the care of women giving birth) Department. This had the potential to affect all patients who presented to the ED or OB to obtain a MSE and were subsequently sent home or transferred to sister facility. The OB average daily census was 12, the average monthly census was 360, and the total transfers was 17 for April through September 2014. The facility census was 55.

Findings included:

1. Record review of the facility policy titled,"EMTALA: Emergency Medical Screening/Emergency Department Call Coverage," approved 06/24/14, showed a MSE refers to the process to determine if an Emergency Medical Condition (EMC) exists. This screening must be done within the facility's capability and available personnel. The MSE 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.

2. During interviews on 10/14/14 at 1:50 PM and 2:10 PM, Staff E, Registered Nurse (RN) and Staff F, RN, both stated that if a patient presented to the ED and was less than 20 weeks pregnant she would be seen in the ED. If a patient was greater than 20 weeks pregnant she was seen by OB. The same practice was followed for patients who presented by ambulance.

3. Record review of the Emergency Medical Services (EMS) form titled,"Patient Care Record," dated 09/26/14, showed EMS took Patient #20 to the OB Department. A nurse from the facility told the EMS staff that OB was overfilled. The facility staff failed to examine the patient prior to EMS transfer to facility B.

4. Record review of the ED and L&D log showed no evidence of Patient #20's arrival to the department. There was no medical record for Patient #20 available.

5. During a phone interview on 10/15/14 at 3:40 PM, Staff V, Paramedic, stated that upon arrival at the hospital OB unit with Patient #20, he was told by a nurse (he did not know which nurse) that OB was overfilled and maybe EMS could take the patient to another facility. Staff V stated that the nurse failed to even speak with the patient. EMS transferred the patient to facility B which had beds available.

During an interview on 10/15/14 at 1:35 PM Staff BB, RN, stated when Patient #20 came in there were approximately five active labor patients, 3 of the 4 triage (exam rooms) were full. The Post Anesthesia Care Unit (PACU) had 2 open beds. At approximately 2:00 AM on 09/26/14, Patient #20 was brought to OB by EMS crew per stretcher. Staff BB stated that she tried to reach EMS by phone before their arrival to possibly take the patient to a sister facility. Staff BB stated that the unit was busy and there was one triage room with an open bed for a patient. Staff BB stated to EMS that the patient may have to stay in the triage room after delivery until a room was available. At this time the patient declined to be transferred to the sister facility suggested by Staff BB. Staff BB, then overheard the EMS staff calling a hospital suggested by the family. Staff BB then stepped away to assist in a delivery room. A short time later Staff BB received a phone call from facility B. The caller requested that if a patient was being transferred, that the physician should call facility B with a patient report and a specific telephone number was given. Staff BB then returned to the entrance of OB unit and observed that EMS and the patient were not present.

During an interview on 10/15/14 at 1:00 PM Staff L, Director of Peri-Natal (all obstetric services), stated that she would have expected Patient #20 to be evaluated in triage and a MSE performed.












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