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Based on review of facility documents, medical records (MR), and staff interviews (EMP), it was determined the facility failed to provide adequate staffing in the Emergency Department to allow for EMS to transfer care to the facility in a timely manner for four of seven medical records reviewed (MR1, MR2, MR3, and MR4).

A review of MR1 revealed the patient was transported by ambulance to the hospital.
The review of the "Emergency Medical Services" documentation revealed the following:

"... 11:45 The patient was registered with YH(York Hospital) PSS and assigned to room 338 per flow nurse. EMS stayed with the patient outside of room 338 till the current occupant was transferred...
12:58 Patient care and report given to nursing staff at the nursing station ..."

The review of the "ED Care Timeline" revealed the following:
"... 10/29/2019 11:45 to 10/29/2019 18:50 ...
11:45 Patient arrived in ED...
12:51:51 Patient roomed in ED To room AA338...

The patient waited approximately 73 minutes for care to be transferred from EMS to the hospital.

A review of MR2 revealed the patient was transported by ambulance to the hospital.
The review of the "... EMS Patient Care Record" revealed the following:
"... Incident Times ... At Destination 15:54:36 ... Pt. Transferred 16:45:00..."

The review of the "ED Care Timeline" revealed the following:
"... 10/14/2019 15:58 to 10/15/2019 01:48:18 ...
15:58 Patient arrived in ED...
17:08:25 First Provider Evaluation of Patient"

The patient waited arrived at 15:54 and care was transferred from EMS to the hospital at 16:45. The patient waited approximately 51 minutes for care to be transferred from EMS to the hospital.

A review of MR3 revealed the patient was transported by ambulance to the hospital. The review of the "Emergency Medical Services" documentation revealed the following: "14:52 Upon arrival at YH, the patient was unloaded from the ambulance on the litter and moved into the facility. Pt registered and was evaluated by a physician before being seen by the Triage Nurse.
16:07 Pt care transferred via verbal report to _____RN(name redacted) and Transfer of Care form signed."

The review of the "ED Care Timeline" revealed the following:
"... 10/14/2019 14:58 to 10/15/2019 02:10:53...
14:58 Patient arrived in ED...
16:08:26 Patient roomed in ED To room RA261 ..."

The patient waited arrived at 14:52 and care was transferred from EMS to the hospital at 16:07. The patient waited approximately 69 minutes for care to be transferred from EMS to the hospital.

A review of MR4 revealed the patient was transported by ambulance to the hospital.
The review of the EMS "Patient Care record" revealed the following:

"... Narrative: ... Due to hospital overcrowding, the patient remained with EMS in the hallway for 2 hours before being moved to a room. While waiting foe a bed, it was brought to the Charge Nurse's attention that the patient was becoming more uncomfortable, experiencing more pain to the back of their head and back and becoming extremely anxious while lying on the board for that period of time. At this time the pt was also removed from the backboard while awaiting for a hospital room by 2 or 3 RNs and an ER Physician. The pt had an emesis episode with hematemesis noted, which had a coffee ground texture. The pt was taken to room 336 where the pt was moved to the hospital bed via sheet move. A report was provided to YH RN by ALS and pt care was transferred to the same at this time ...
At Destination 13:45
Patient Transferred 15:45

The review of the "ED Care Timeline" revealed the following:
"... 10/14/2019 13:49 to 10/14/2019 19:49...
13:49 Patient arrived in ED...
15:41:17 Patient roomed in ED To room AA336..."

The patient waited arrived at 13:49 and care was transferred from EMS to the hospital at 15:41. The patient waited approximately 112 minutes for care to be transferred from EMS to the hospital.

An interview was conducted on November 7, 2019 with EMP13. EMP13 confirmed the patient remained under the care of EMS until the care was transferred to the ED staff.

Based on review of facility documentation, medical records (MR), and staff interview (EMP), it was determined the facility failed to follow their policies and procedures related to vital signs and reassessment of patients in the Emergency Department for three of seven Emergency Department medical records (MR1, MR2, and MR7).

Findings include:

A review of facility policy revealed "...Emergency Policy & Procedure...Date Most Recently Reviewed 10/2019...Nursing Documentation Standards...IV. Procedure: A. Every Patient: 1. Must have a GCS(Glasgow Coma Scale/Score) and vital signs within 10 minutes of arrival..."

The facility was not able to provide a policy that addressed "parking"(Patient parking occurs when ambulance services arrive with their patient, but the hospital staff does not immediately come to assess the patent to accept care) of patient in the Emergency Department.

Interview conducted on November 8, 2019, with EMP13 confirmed that the policies did not address parking of patients in the ED.

A review of MR1 revealed the patient was transported by ambulance to the hospital. According to the "ED Care Timeline", the patient arrived at the ED on 10/29/19 at 11:45. The patient's vital signs were not taken until 13:04, 79 minutes after the patient presented to the ED.

A review of MR2 revealed the patient was transported by ambulance to the hospital. According to the "ED Care Timeline", the patient arrived at the ED on 10/14/19 at 15:58. The patient's vital signs were not taken until ........................., minutes after the patient presented to the ED.

A review of MR7 revealed documentation on the "ED Care Timeline" which indicated that the patient arrived at the ED on 9/25/19 at 17:45. The patient's vital signs were not taken until 20:44, 179 minutes after the patient presented to the ED.

An interview was conducted on November 8, 2019 with EMP13 revealed that the patients did not receive care in accordance with the policy of the hospital. EMP13 indicated that the policy states that patients have vital signs within 10 minutes of admission and that was not done.

Cross Refer to 482.23(b) Staffing and Delivery of Care
Cross Refer to 482.55 (a)(3) Emergency Services Policies

Based on a review of facility policy, medical records, and staff interviews (EMP), it was determined that York Hospital failed to assume care of Emergency Department patient that presented to the Emergency Department, leaving the patients in the care of EMS for four of seven Emergency Department medical records reviewed (MR1, MR2, MR3, and MR4).

A review of MR1 revealed the patient was transported by ambulance to the hospital.
The review of the "Emergency Medical Services" documentation revealed the following:

On 10/29/19, the patient arrived at the ED at 11:45. The patient was left in the care of EMS until EMS transferred care 73 minutes later at 12:58.

A review of MR2 revealed the patient was transported by ambulance to the hospital.
The review of the "ED Care Timeline" revealed that the patient arrived at the ED at 15:58 on 10/14/19. The patient was left in the care of EMS until EMS transferred care 51 minutes later at 15:58.

A review of MR3 revealed the patient was transported by ambulance to the hospital. The review of the "ED Care Timeline" revealed the following: On 10/14/19, the patient arrived in the ED at 14:58. The patient was left in the care of EMS until EMS transferred care 70 minutes later at 16:08.

A review of MR4 revealed the patient was transported by ambulance to the hospital. The review of the "ED Care Timeline" revealed the following: The patient arrived at the ED on 10/14/19 at 13:49. The patient's care was transferred from EMS to the hospital at 15:41, 112 minutes after arriving at the hospital via ambulance.

An interview was conducted on November 7, 2019 with EMP13. EMP13 confirmed the patient remained under the care of EMS until the care was transferred to the ED staff.

Cross Refer to 482.23 (b) Staffing and the Delivery of Care