HospitalInspections.org

Based on document review and staff interview it was determined in 1 of 20 (Pt #1) ED patient being medically screened for a medical emergency that the Hospital failed to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24.

Findings include:

1. The Hospital failed to provide the patient with an appropriate medical screening. (A2406).

Based on document review and interview it was determined the Hospital failed to provide a Medical Screening Examination for 1 of 20 patient (Pt. #1) presenting to the emergency department for medical care.

Findings include:

1. The hospital policy titled, " EMERGENCY DEPARTMENT STANDARDS & PRACTICE MANUAL; EMERGENCY SERVICES (ES); SUBJECT: ASSESSMENT OF THE EMERGECY DEPARTMENT PATIENT; POLICY AND PROCEDURE: (Effective June 2015) was reviewed on 3/30/2016 at 1:15 PM required- A. All patients presenting to the Emergency Department (ED) will be triaged and categorized using Emergency Severity Index (ESI)"


2. On 3/29/16 at 9:30 AM, the document titled,"INQUIRY/ASSESSMENT FORM" was reviewed. On 3/22/16 at 9:16 PM the psychiatric RN (E #5) documented Pt # 1 Presenting Problem: Schizophrenia. Non-Compliant w/ meds and doctor appts...no SI (Suicidal Ideation) or Hallucinations. Grandma and Mom are w/ him in ER. At 11:07 PM Psychiatrist (E #2) was contacted by E #5 and Pt #1 was to be ADMITTED: Voluntary; Medically cleared by Transferring Hospital; Provisional DSM IV diagnosis: Psychotic Disorder.

3. On 3/29/16 at 3:00 PM, Pt #1's "Account Detail" was reviewed. Documentation indicated Pt #1 arrived to the registration window on 3/23/16 (no time recorded) to sign consents. According to the Switchboard/Registration clerk (E #6), Pt #1 was stating "there was a misunderstanding and he wasn't supposed to be here." Pt #1 refused to sign admission forms. Further documentation indicates Pt #1 was then taken to the psychiatric unit by EMS. The psychiatric RN (E #5) spoke with Pt #1 regarding admission, but Pt #1 again refused to be admitted, "wanting to go to another hospital by St. Louis". Documentation indicated the EMS left the hospital with Pt #1 (no time documented).

4. On 3/29/16 at 3:10 PM, a phone interview was conducted with E #5. E #5 remembers Pt #1 would not sign in at the registration desk. Pt #1 was brought up to the psychiatric unit "so we could talk". Pt # 1 indicated he misunderstood and thought he was being transferred to a hospital near St. Louis. He verbally refused to be admitted and this was documented in Meditrend and sent to the Supervisor. "Told EMT's they would have to take him back and they left with Pt."
5. On 3/29/16 at 1:00 PM, a review of the transcribed report of the "Ambulance Recording" was conducted. On 3/23/16 at 2:40 AM, a conversation occurred with EMS and the Hospital ED. Documentation indicated Pt #1 was being brought back to the Hospital ED per instructions of transferring hospital. Pt #1 arrived approximately at 2:41 AM to the Hospital.

6. On 3/29/16 at 2:15 PM, a telephone interview was conducted with the RN House Supervisor (#3). E #3 recalled Pt #1's refusal to be voluntarily admitted once arriving at Hospital. E #3 stated, "The patient was over an hour from home and did not want to be here, so we sent him back." Once the ambulance left with Pt #1 "We were notified by EMS that they were bringing him back." E# 3 stated, "I told EMS the patient was refusing to be admitted. EMS told me they were instructed to take Pt #1 to the closest ED, which would be us." When the ambulance arrived, E #3 stated, "I went outside and told them to wait, I think he has to go back." E# 3 called the Transferring Hospital and then spoke with the psychiatric unit supervisor. It was agreed to screen Pt #1 in the ED. E# 3 stated, "I went outside to have them bring patient in, and the ambulance was pulling away." E #3 confirmed, Pt #1 did not receive a medical screening.

7. On 3/29/16 at 3:45, video surveillance of EMS arrival and departure was observed. The EMS arrived at approximately 2:40 AM on 3/23/16 and left at approximately 2:51 AM. Pt #1 never left the ambulance and was not taken inside the ED for care.