HospitalInspections.org

Based on interview, record review and a review of facility documentation, the facility failed to ensure that policies and procedures governing medical care provided in the emergency department in the form of timely responses by on-call physicians were followed for 1 of 10 sampled patients (#1).

Findings:

A review of the medical record of patient #1 was performed. The patient was admitted to the emergency room (ER) on 12/27/13 at 10:43 PM. A nurse's note at this time read, "Pt (patient) reports 14 weeks preg (pregnant) with vag (vaginal) bleed X 1 week. Bleed became heavy today with clots blood soaked towels."

The ER physician saw the patient at 9:51 PM on 12/27/13. A nurse's note of 12/28/13 at 12:52 AM read, "Spoke with (nursing supervisor) regarding 4 calls over 1.5 hours trying to reach on-call OB (Obstetrician). Dr...after hanging up with (nursing supervisor), Dr. (Obstetrician) returned call at this time and is now on the phone with Dr. (ER physician) for consult." Thus, the nurse reported to the nursing supervisor that it took 90 minutes to contact the physician.

A physician note of 12/28/13 at 3:22 AM read, "Consultant called: OB/GYN (Obstetrics/Gynecology). Requested call time: 11:40 PM. Requested call date: 12/27/13. Call returned time: 12:55 AM. Call returned date: 12/28/13. Thus, the physician noted a response of 75 minutes minutes later.

A review of the "ED Physician Call Log" revealed that the first call to the OB/GYN was placed at 11:18 PM on 12/27/13 and was answered at 12:54 AM on 12/28/13, a duration of approximately 90 minutes.

A review of the "Emergency On Call Schedule" revealed that the on-call obstetrician, as written, was the one who was on-call for OB/GYN (Obstetrics/Gynecology) on 12/27/13.

A review of hospital's policy "EMTALA -Florida Provision of On-Call Coverage Policy" read, "The hospital has a process to ensure that when a physician is identified as being 'on-call' to the DED (dedicated emergency department) for a given specialty, it shall be that physician's duty and responsibility to assure the following: Immediate availability, at least by telephone, to the DED physician for his or her scheduled 'on-call' period, or to secure a qualified alternate if appropriate. Arrival or response to the DED within a reasonable timeframe (generally, response by the physician is expected within 30 minutes.)" Since the on-call physician had not responded within the thirty minute time frame, he was in violation of this policy.

During an interview of the Risk Manager at 2:15 PM on 2/20/14, she confirmed the findings.