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Based upon interviews, medical record review and document review, it was determined that the facility failed to have policies and procedures in effect to ensure compliance with 42 CFR 489.24 and the related provisions at 42 CFR 489.20.

Findings include:

-Review of the Emergency Department log and corresponding medical records revealed the facility did not comply with all of the provisions of a medical screening exam. Please reference findings under Tag A2406.

Based on medical record review, document review and interview, there is no evidence to indicate all patients are screened, beginning with triage, to determine if an emergency medical condition exists and to prioritize when the individual will be seen by a physician or other qualified medical personnel in 3 out of 7 patients who presented to the Emergency Department (ED) and left without being seen. (Patient #1, 2 and 3)

Findings include:

-Review of the policy and procedure entitled "Patient Triage Process" dated 11/30/09 revealed under triage guidelines that an ED registered nurse performs the triage function with triage categories assigned based on a five-tier acuity system. The goal of the ED is to have the triage process initiated within 15 minutes of a patient's arrival to the ED.

-Interview with Staff #1 on 8/4/10 revealed "99% of patient triage is done at the bedside". Due to the patient volume, a specific nurse is not assigned to triage. Instead the nurse assigned to care for the patient conducts the triage at the bedside. When all ED beds are full, the triage room located adjacent to the ED waiting room can be used for triage.

-Review of the ED Record for Patient #1 dated 6/28/10 revealed the patient presented to the ED at 7:14pm with complaints of back pain and left at 7:55pm before triage was conducted.

-Review of the ED Record for Patient #2 dated 7/15/10 revealed the patient presented to the ED at 10:14pm with complaints of shortness of breath and left at 11:50pm before triage was conducted.

-Review of the ED Record for Patient #3 dated 6/28/10 revealed the patient presented to the ED at 7:15pm with complaints of a urinary problem and left at 8:21pm before triage was conducted.

These findings were verified with Staff #1 and Staff #10 on 8/5/10.