HospitalInspections.org

Based on observations and staff interview, during an emergency room tour, the facility failed to display Emergency Medical Treatment and Active Labor Act (EMTALA) signage in places likely to be noticed by all patients entering the Emergency Department. Specifically, in the patients and visitors area on the 4th floor, Obstetrics, Labor and delivery unit.

On September 18, 2013 at approximately 11:20 am, during a tour of the Labor and Delivery area (4th floor), there was no Emergency Medical Treatment and Active Labor Act (EMTALA) signage posted in the entrance, admitting area or waiting room.

On September 18, 2013 at approximately 11:20 am an interview with staff #1 who stated "there were signs, but I do not know what happen to them". When the surveyor inquired further and asked staff #1 why there are no signs, staff #1 stated, "the signs may have been taken down when the walls were being painted" .

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Based on review of the Emergency Department (ED) Central Log and interview, it was determined that the disposition of individuals seeking assistance in the ED was incorrect and not consistently documented. This was noted in 6 (six) of 32 (thirty-two) medical records reviewed. (MR #1, 2, 3, 4, 5, and 6)
Findings include:
Review of MR #1 on 9/19/13 noted this patient arrived to the ED via ambulance on 4/1/13 at 4:59PM. The patient was triaged at 5:04PM with a chief complaint of high glucose at home and in triage. Vitals signs were noted to be Temperature (T): 97.1, Pulse (P): 98, Respiration (R): 20, Blooe Pressure (B/P): 109/73 and no pain. The patient was seen and examined, had blood drawn for labs and blood. Glucose (bloos sugar) noted to be 580 MG/DL (blood sugar levels before meals range70 to 80 mg/dL). Glucose noted to be 548 MG/DL at 7:30PM. Nurse's notes indicated that the "patient not in room when RN came to check blood sugar and administer medications."
The Physician's documentation indicated that this patient eloped at 10:55PM and also left AMA at 10:56PM. There was no disposition noted for this patient in the ED log.

Review of MR #2 on 9/19/13 noted this 65 year old patient arrived to the ED via ambulance on 3/24/13 at 5:00pm with a chief complaint of S/P seizure. The patient was triage at ESI 3-Urgent, vital signs were noted to be: T: 97.8, P: 80, R: 20, B/P: 141/87 and no pain.
Nursing documentation on 3/24/13 at 5:15pm indicated that the "patient wanted to leave ED before being seen. Patient is AO @3 was interviewed by Dr. (name recorded) and permitted to walk out." There were no physician's notes to indicate that the physician counseled this patient regarding leaving the ED.
Nursing documentation on 3/24/13 at 5:17PM indicated the patient left before being seen.The ED log indicated that this patient left AMA, there was no AMA form located in the record.

Review of MR #3 on 9/19/13 noted this 55year old patient arrived to the facility via ambulance on 6/1/13 at 5:50PM with a chief complaint of "fall, syncope?, Alcohol intoxication". Triage ESI level 3-urgent. Vital signs were noted to be: T: 98.6, P: 84, B/P: 109/64, R: 18.
The patient had blood drawn for labs, EKG, CT Brain without contrast and was admitted to Telemetry. There was no disposition noted for this patient in the ED log.

Review of MR #4 on 9/19/13 noted this 61 year old patient presented to the facility at 9:58AM accompanied by family member with a chief complaint of agitation, not eating, not taking medications and inappropriate behavior. Triage ESI level - 3. Vital signs noted to be T: 96.9, P: 98, R: 20, B/P: 136/97.
The patient was seen and examined by the physician and had a psychiatric consult. The physician's notes indicated the patient was admitted to inpatient psychiatry. There was no disposition for this patient noted in the ED log.

Review of the MR # 5 on 9/19/13 at 11:00 AM revealed that this 14 year old male patient presented to the hospital on 5/11/13 with chief complaint of aggressive behavior and psychiatric evaluation.
Patient was seen and evaluated by a psychiatrist, the psychiatrist recommended discharge when medically cleared, and instructed patient to follow up with usual psychiatrist next week.
Patient was examined by medical physician, his condition improved, and he was discharged home.

The 5/11/13 ED Log listed the patient's disposition as "Intra - Campus transfer to (hospital identified)" and not the correct disposition, which was discharge home.


Review of MR # 6 on 9/19/13 at 10:30 AM revealed that this 8 year old female patient presented to the hospital on 5/8/13 with complaint of fever and headaches. Her medical condition was evaluated and the ED physician's impression was seasonal allergies.

Patient was discharged home with medications and instructed to follow-up with private physician and to return to the ED if condition worsened.

The 5/8/13 ED Log listed the patient's disposition as transfer to Cancer/Children Hospital and not the correct disposition which was noted as discharge home.

Interview with Staff #2 on 9/19/13 at about 1:00pm regarding the ED log incorrect disposition, he stated that correction were made to the drop down box, but when the system is updated it reverts back to the previous choices.