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Based on review a of the medical records [MR] and facility documentation. It was determined the facility failed to comply with 482.23 (b) by failing to following policies and procedures for providing respectful privacy care and patient rights when completing initial assessment for treatment care plan for emergency department patients. (Refer to A0093)

The policy titled: "Patient Bill of Rights and Responsibilities" Publication Date: July 27, 2023; was reviewed and stated in part: "...III. Procedure: A. Patient Rights 1. The patient has the right to receive considerate and respectful care..."

The policy titled: "Admitting a Patient (Nursing)" Publication Date: December 17,2024; was reviewed and stated, in part, "Purpose: Process for all...hospital admission; Definitions... Boarder Patient: A boarder is defined as patient in the Emergency Department [ED] who has a Patient Status Order [PSO] for admission and no available bed on the appropriate unit/facility. Therefore, the patient must wait, or board, in the Emergency Department until a bed is available...Patient Status Order which determines what level of care the patient is to receive by the Admitting Provider, e.g. inpatient, outpatient, observation, outpatient in a bed...Procedures: Emergency Department: 1. The patient's ED work is completed and the ED provider has determined the patient needs admitted to the hospital. 2. The ED provider consults the access coordinator to ensure bed is available prior to consulting admitting physician. If bed available, ED provider will consult the admitting physician for admission or observation placement of the patient...3. Admitting physician places PSO in Cerner. I. PSO will state bed type, admission status, and the name of the patient's attending physician. 4. PSO order alerts the Transfer Center that the patient needs a bed...5. The Transfer Center assigns the patient a bed. For Plateau Medical Center, Access Coordinator will assign a bed in PM office once patient arrives to receiving unit. If a bed is not available, the patient will board in the ED until a bed become available."

The policy titled: "Professionalism: Interactions with Patients and Families" which was in the additional GME Policies for Residents and fellows in CAMC program. The policy was undated was reviewed and stated, in part, "Residents/fellows are reminded that...public areas to respect the privacy concerns of patients. Hallway...are inappropriate as they may be overheard by unauthorized individuals. House staff must at all times be respectful and professional in all interaction with patients, families...in their communication to other health professional about patients.

A review of the History and Physical Final; Assessment and Plan dated 12/11/24 at 7:33 p.m. completed by Staff #20 revealed the concerns for Patient #1 bowel obstruction were: Patient with several months of varying abdominal distention and ostomy output, Patient recently had been more distended and had decrease output, A computed tomography [CT] shows colon is very distend and fluid-filled. Distal small bowel is also mildly dilated. Transition point is seen at the level for the ostomy in the left lower quadrant, concerning for possible intermittent obstructions, Abdomen is significantly distended, no tibial tubercle osteotomy [TTP] or rebound/guarding, ostomy is pink and patient down to fascia, admit to surgery services, Nothing by mouth [NPO] will not place nasogastric [NG] tube at this time as patient has had no nausea and vomiting, will attempt decompression with red rubber, this was ultimately unsuccessful, on interval check, patient has emptied ostomy bag twice with good output, bowel rest maintenance intravenous fluids [mIVF]."

Interview was conducted on 1/14/25 at 2:00 p.m. with Staff #6, who confirmed that, "I saw the patient a total of three (3) times. Once in the MERT area where the recliners are located. The second was when I assessed the patient in the hallway. I did a digital and when I put my finger in the stoma area of the patient. The third time was when I did a follow up to check on the patient after my first initial assessment of the stoma. The patient expressed to me that [he/she] was upset because I assessed the coloscopy bag and did the stoma examine in the hallway. I told [him/her] I would not do that again if I had to examine the patient again, I would do the examine in a private area of the ED."

Interview was conducted on 1/15/25 at 12:06 p.m. with Staff #20, who confirmed that, "I was not present at the time [Staff #6] completed the assessment on [Patient #1]. Another Resident was assigned with [Staff #6] which was [Staff #13]. Which both of these individuals are Residents. Resident can do consults, write notes/progress notes which has to be sent to the attending physician."

Based on review of medical records [MR] and facility documentation, it was determined that facility failed to comply with 482.13 (c) (1) by failing to provide the right of personal privacy during a medical assessment. (Refer to A0143)

Findings include:

Review of the facility policy "Patient Bill of Rights and Responsibilities" published date: July 27, 2023, revealed and stated in part ... "The patient has the right to personal privacy.

A review of the History and Physical Final; Assessment and Plan dated 12/11/24 at 7:33 pm completed by Staff #20 revealed the concerns for Patient #1 bowel obstruction were: Patient with several months of varying abdominal distention and ostomy output, Patient recently had been more distended and had decrease output, A computed tomography [CT] shows colon is very distend and fluid-filled. Distal small bowel is also mildly dilated. Transition point is seen at the level for the ostomy in the left lower quadrant, concerning for possible intermittent obstructions, Abdomen is significantly distended, no tibial tubercle osteotomy [TTP] or rebound/guarding, ostomy is pink and patient down to fascia, admit to surgery services, Nothing by mouth [NPO] will not place nasogastric [NG] tube at this time as patient has had no nausea and vomiting, will attempt decompression with red rubber, this was ultimately unsuccessful, on interval check, patient has emptied ostomy bag twice with good output, bowel rest maintenance intravenous fluids [mIVF].

An interview was conducted on 1/14/25 at 9:00 a.m. with Staff #1, who confirmed that, "[Staff #6] is a third [3rd] year resident at the hospital
Interview was conducted on 1/14/25 at 2:00 p.m. with Staff #6, who stated, "I saw the patient a total of three [3] times. Once in the MERT area where the recliners are located. The second was when I assessed the patient in the hallway. I did a digital and when I put my finger in the stoma area of the patient. The third time was when I did a follow up to check on the patient after my first initial assessment of the stoma. The patient expressed to me that [he/she] was upset because I assessed the coloscopy bag and did the stoma examine in the hallway. I told him I would not do that again if I had to examine the patient again, I would do the examine in a private area of the ED.

Interview was conducted on 1/15/25 at 12:06 p.m. with Staff #20, who stated, "I was not present at the time [Staff #6] completed the assessment on [Patient #1]. Another Resident was assigned with [Staff #6] which was [Staff #13]. Which both of these individuals are Residents. Resident can do consults, write notes/progress notes which has to be sent to the attending physician."