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Based on observation and interviews it was determined the facility did not provide a functioning call bell system in the Emergency Department (ED). This finding was noted in one of ten hospital units toured.

The failure to provide the patient with a call bell places the patient's safety and security at risk.

Finding includes:

During tour of the Emergency Department on 7/21/15 between 11:30 AM and 1:15 PM, it was observed that there was no functioning Call Bell System.

During the tour, Patient #2, a left arm amputee was observed sitting in bed and grimacing. Upon interview of the patient on 7/21/15 at 11:45 AM, he stated he was seeking the attention of a nurse to provide him with a urinal. The patient stated he had no call bell and had waited 45 minutes for assistance.

Patient #3 was observed on 7/21/15 at 11:47 AM in a private room with doors closed and was maintained on contact isolation. The patient had no functioning call bell to alert a nurse of the need for any type of assistance.

At interview with Staff #3 on 7/21/15 at 11:50 AM, she stated the call bell system in the ED is no longer supported by the manufacturer and was taken out of use. She stated nurses are always in the patient care area to assist patients as needed.

Staff #4 on 7/24/14 at 12:45 PM, confirmed the findings.

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Based on observation and interviews, the facility did not maintain the call bell system in the Emergency Department to assure the safety and well-being of patients.

Findings Include:

During tour of the Emergency Department on 7/21/15 between 11:30 AM and 1:15 PM, it was observed that there was no functioning Call Bell System.

See specific findings noted under A0144.

Based on interviews, review of medical records, and other documents, it was determined that the hospital failed to develop and implement policies that assure patient care needs are met when a surgeon becomes incapacitated. This finding was noted in 1 of 10 medical records reviewed.

The facility's failure to develop a plan to address a situation when the surgeon becomes incapacitated during a procedure, places all surgical patients at risk for poor outcomes.

Findings include:

Review of medical record for Patient #3 on July 22, 2015 notes a 64-year-old male with surgical history significant for total knee replacement and total right hip arthroplasty. The patient was admitted to the facility on 11/22/14 and he underwent a Total Right Hip Arthroplasty with Prosthesis on 11/28/14. The surgery began at 2:31 PM and ended at 5:40 PM.

During the course of the procedure, the orthopedic surgeon became incapacitated. The Operating Room (OR) nurse notes at 3:49 PM, "Surgeon felt sick, looks pale, stepped out of room. After a while comes back and continued procedure." The anesthesiologist notes at 3:49 pm, "Surgeon out of OR, operative site packed. Patient is stable". At 4:22 PM, the anesthesiologist notes, "Surgeon returned to OR, second surgeon scrubbed in". The surgeon was absent from the OR for 32 minutes.

Interview with Staff #3, Chief Medical Officer (CMO), and Staff #4, House Surgeon on 7/21/15 at approximately 12:30 PM, Staff #4 who was present during procedure stated he is a general surgeon with no experience with orthopedic surgery and he was unable to continue the surgery in the absence of the surgeon. Staff #3 confirmed Staff #4 was not qualified to perform orthopedic surgery.

At interview with Staff #5, Physician Assistant on 7/23/15 at approximately 1:30 PM, he stated the patient's operative site was exposed and the area had been reamed in preparation for the insertion of the prosthesis. The periosteum of the bone was oozing blood and the patient had required infusion of three units of packed red cells. Staff #5 stated it was imperative for the prosthesis to be inserted as it acts as a tamponade controlling bleeding. He stated that he and the rest of the surgical team monitored the patient in the absence of the ill surgeon. When the surgeon returned to the OR about 32 minutes later, he completed the surgery.

At interview with staff #3 on 7/23/15 at 11AM, he stated that when the surgeon felt faint, other OR staff removed him and took him into the Post-Anesthesia Care Unit. He stated there were no on-call orthopedic surgeons and the two orthopedic surgeons who were called could not come in. He stated that neither the two surgeons in the hospital at that time were qualified to assist in the orthopedic procedure. He stated there was no option to transfer the patient to another hospital and that it would have taken 90 minutes for an orthopedic surgeon from another campus to respond. It would take 90 minutes for them to come in, in any case. He stated that he authorized the return of the surgeon to the OR to complete the surgery based upon information provided to him by the house surgeons as to their impression of the surgeon's ability to continue the surgery.

Review of the policy titled "Medical Staff Services-Physician Wellness Guidelines" original issue 1/8/2003 and reviewed on 2/15 found that it addresses the steps to be taken when impairment secondary to mental illness or addiction is suspected or confirmed. The policy does not address what actions need to be taken when impairment or illness represents an immediate threat to patient safety.

At interview with Staff #3 on 7/23/15 at 11:30 AM, he stated there is no policy on the steps to follow when an operating surgeon becomes impaired. He stated the surgical team takes steps based upon a huddle and that there is no prescriptive procedure to follow.

The review of the Emergency Department on-call schedule for Orthopedic Surgery, found that the orthopedic surgeon who became ill was the on-call surgeon for that day. There was no OR on-call schedule for Orthopedic Surgery.