HospitalInspections.org

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Based on observation, interview, record review and review of hospital policies and procedures, the hospital failed to develop and implement policies and procedures for evaluation and treatment of patients presenting for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health care outcomes, injury, and death.

Findings included:

1. The hospital failed to ensure that all patients who presented to the Emergency Department (ED) were included in the hospital's ED log.

Cross Reference: C 2405

2. The hospital failed to provide a medical screening examination for the complaint index patient who was not registered.

Cross Reference: C 2406

3. The hospital failed to ensure that patients who decided to leave the hospital's ED against medical advice (AMA) would have documented that on the hospital's "Leaving Hospital Against Medical Advice" form for 1 of 4 patients who left against medical advice.

Cross Reference: C2407

4. The hospital failed to ensure that patients being transferred to other facilities had documentation on the hospital's "Interfacility Transfer Form" for 4 of 6 patients transferred to another facility.

Cross Reference: C 2409
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Based on interview, document review and review of hospital policies and procedures, the hospital failed to ensure that registration staff registered all patients presenting for care at the Emergency Department.

Failure to register all patients risks poor patient outcomes due to lack of medical screening examination, stabilizing treatment, and appropriate disposition.

Findings included:

1. Review of the hospital's policy titled, "EMTALA-Emergency Medical Treatment and Labor Act," number 12001651, approved 09/22, showed that hospital departments where a patient may present for emergency services or receive a medical screening examination, including the Emergency Department (ED), shall maintain Central Logs, which identify the patients who have presented for such services, along with a description of the outcome of their presentation.

2. Review of the hospital's ED logbook showed that the complaint subject patient was not included in either the electronic or paper logbook.

3. On 06/27/23 at 2:22 PM, during an interview with the investigator, the Quality Manager, (Staff #1) verified that the complaint subject patient was not present in the ED logbook on 03/23/23.

4. On 06/28/23 at 7:38 AM, during an interview with the investigator, a patient registration clerk, (Staff #3), stated that the patient is entered into the logbook during triage. Registration and nursing triage occur in the same room at the same time. If a patient decided they didn't want to be seen in the ED before triage was completed, the patient would not be in the logbook.

5. On 06/28/23 at 7:50 PM, during an interview with the investigator, a patient registration clerk (Staff #4) stated that when a patient comes in asking for the ED, they take the patient to the triage room and start checking them in. If the patient changes their mind before seeing a nurse, they don't make the account. The account creates the patient sticker that is placed into the logbook, so that patient would not be entered into the logbook.
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Based on interview, document review and review of hospital policies and procedures, the hospital failed to ensure that all patients that present to the hospital for emergency care receive a medical screening examination for 1 of 26 medical records reviewed (Patient #26).

Failure to ensure patients received a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health outcomes, injury, and death.

Findings included:

1. Review of the hospital's policy titled, "Obstetrical Patient in the Emergency Department," number 12001629, approved 08/22, showed that when an obstetrical patient presents to the Emergency Department (ED), the ED provider would provide a medical screening exam and refer to the nearest appropriate facility for care and/or delivery, following EMTALA guidelines.

2. Review of the hospital's policy titled, "EMTALA-Emergency Medical Treatment and Labor Act," number 12001651, approved 09/22, showed that all patients requesting emergency services receive an appropriate medical screening examination as required by the Emergency Medical Treatment and Active Labor Act.

3. Review of the complaint intake document showed that a patient who was 17 weeks pregnant, with a history of premature delivery, arrived at the hospital's ED on 05/23/23, and was told by the admitting staff that if this was a pregnancy complaint they should just drive to Omak.

4. Review of the ED electronic log from 01/01/23 through 06/26/23 showed that the complaint subject patient was not registered at North Valley Hospital at any time.

5. On 06/27/23 at 2:45 PM, during an interview with the investigator, a patient registration clerk, (Staff #2) stated that if a patient stated that they are pregnant, they tell them that the hospital has no obstetrics department so a better option may be to go to Omak, they have OB there.
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Based on interview, document review and review of hospital policies and procedures, the hospital failed to obtain, or attempt to obtain, a written refusal of care for 1 of 4 patients leaving against medical advice (AMA) (Patient #12).

Failure to obtain a written refusal risks patients' lack of understanding of the risks and benefits of remaining at the facility until an appropriate transfer for care could be facilitated resulting in possible patient injury or death.

Findings included:

1. Review of the hospital's policy titled, "Against Medical Advice/Refusal of Treatment Form," number 13335713, approved 03/23, showed that all patients indicating the desire to leave against medical advice (AMA) shall sign an AMA form. If a patient refuses to sign the form, the nurse or physician shall complete an AMA form, indicating the patient's refusal to sign AMA/Refusal of Treatment Form.

2. Review of the medical record showed that a patient left before treatment was complete, but there was no AMA form located in the patient's record (Patient #12).

3. On 06/27/23 at 2:22 PM, during an interview with the investigator, the Quality Improvement Manager (Staff #1) stated that there was no AMA form located in the medical record of Patient #12.
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Based on interview, review of medical records and documents, and policy and procedure review, the hospital failed to document all the elements of an appropriate transfer for 4 of 6 medical records of patients who had transferred to another hospital for additional care (Patient #2, Patient #6, Patient #12, Patient #15).

Failure to ensure that the receiving hospital accepted the patient puts patients at risk of bed or staff unavailability at the receiving hospital, resulting in inadequate care or injury.

Findings included:

1. Review of the hospital policy titled, "Transfer of Patient to Another Facility," number 11527066, approved 05/22, showed that if the ER provider determined that the patient should be transferred to another facility for further care, COBRA standards must be followed. Transfer papers would be completed including patient transfer acceptance by the receiving facility and nurse to nurse report.

2. Medical record reviews showed that the Authorization for Transfer documentation did not include the name of supervisor/admitting person accepting the patient for 3 of 6 transfers reviewed (Patient #2, Patient #6, Patient #15).

3. Medical record review showed that the Authorization for Transfer documentation did not include documenation of nurse to nurse report (Patient #9)

4. On 06/27/23 at 12:43 PM, during an interview with the investigator, the Quality Manager (Staff #1) stated that transfer forms for patients #2, #6, and #15 did not include the names of the person accepting the transfers for the receiving hospitals, and that the transfer form for patient #9 did not include documentation of nurse to nurse report.
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