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Based on record review and interview, the hospital failed to be in compliance with 42 CFR §489.20 (l) of the provider's agreement which requires that hospitals comply with 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases 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 provide continuous monitoring to a patient presenting with suicidal ideations until a medical screening was completed to determine if the patient had an emergency medical condition for 1 (#2) of 20 patients reviewed that presented to the pediatric emergency room (see findings Fed-A-2406).

Based on record review, video 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 provide continuous monitoring to a patient presenting with suicidal ideations until a medical screening was completed to determine if the patient had an emergency medical condition for 1 (#2) of 20 patients reviewed that presented to the pediatric emergency room.

Findings:
Review of the hospital's policy titled Observation and Monitoring of Behavioral Patients in the Emergency Care Setting revealed in part:
2. Behavioral patients in the ECU under suicide precautions will have Level 2 observation status unless deemed otherwise by a physician.
3. Observation and monitoring of behavioral patients is delegated from Registered Nurse to appropriate unlicensed staff and the RN attains accountability and supervision. The observation of patients in the Emergency Care setting requiring 1:1 observation or Visual Observation will be performed by a Registered Nurse, Mental Health Tech, Security, or other staff member trained in the observation of this patient population.

Review of Patient #2's emergency department record revealed she was a 15 year old that arrived to the pediatric emergency department with her mother on 3/15/19 at 8:14 p.m. with the chief complaint of having suicidal thoughts. The next documentation was that Patient #2 was triaged in LA-Triage 01 at 9:09 p.m. (55 minutes later). Further review revealed a Suicide Risk assessment was done at 9:11 p.m. by the triage nurse and Patient #2 was scored as a high risk. Patient #2 was then place in room B10 (safe for psychiatric patients) with staff observing her for safety. Patient #2 was seen by a Physician's Assistant on 3/15/19 at 10:45 p.m.

Review of emergency department room availabilty for 3/15/19 revealed a psychiatric safe room (B10) became available at 8:20 p.m. which was 6 minutes after Patient #2's arrival to the registration desk. Further review revealed the room was available until Patient #2 was placed into it at 9:14 p.m.

Review of a Physician's Emergency Certificate dated 3/16/19 at 1:04 a.m. revealed Patient #2 was determined to be suicidal, a danger to herself and unable to seek voluntary admission.

In a telephone interview on 3/22/19 at 8:00 a.m. with Patient #2's mother, she said they registered her daughter as having suicidal thoughts and then they were placed into the waiting room for a long time before being seen. She said they did not have a staff member with them. She said she kept asking to see a doctor and they kept telling her the doctor was busy.

In an interview on 3/22/19 at 9:45 a.m. with S3EDDir, she said if a patient presents to the ED with suicidal ideations or attempt, they will be taken to the back immediately and never wait in the waiting room. She said personnel was automatically assigned to the patient even if they have a family member with them.

In an interview on 3/22/19 at 2:30 p.m. with S4MD, he said if a patient presents as suicidal to the ED they were labeled as a level 2. He said the patient had to see a provider faster if they were a level 2. S4MD said he thought the patient had to be seen in less than 10 minutes but he was not sure. He also said suicidal patients should never go to the waiting room. S4MD said all level 2 patients are taken directly to the back.

In an interview on 3/22/19 at 3:09 p.m. with S5MD, she said she was working in the ED on 3/15/19 and 3/16/19. She said when a patient arrived with suicidal ideations they are taken into triage immediately. She said she had never seen a case where the patient was sent to the waiting room.

In an interview on 3/26/19 at 9:05 a.m. with S1Compliance, she said she reviewed a video of the Pediatric Emergency Department waiting room for the time frame Patient #2 was being admitted on 3/15/19. She said it appears to be Patient #2 and her mother in the video and the time frames correlate with the documentation in Patient #2's medical record. S1Compliance said after Patient #2 was registered, she and her mother did return to the waiting room unsupervised for approximately 40 minutes. S1Compliance said that is not the hospital's usual practice. She said when someone presents as suicidal they are supposed to be either taken into triage or placed in a safe room immediately. S1Compliance said she is not sure why Patient #2 and her mother were allowed to sit in the lobby.