HospitalInspections.org

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Based on interview, record review and review of hospital policies and procedures, the hospital failed to develop and implement policies and procedures for evaluation, treatment and appropriate transfer or discharge 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 the receiving facility and receiving physician accepted the patient in transfer prior to leaving the Emergency Department for 2 of 8 patients transferred (Patient #4, Patient#9).

2. The hospital failed to ensure that the medical records for 2 of 8 patients transferred to another facility included the Patient Transfer forms as required by hospital policies and procedures (Patient#4, Patient#9).

Cross Reference Tag A-2409
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Item #1 No Acceptance of Transfer

Based on interview, document review, and review of hospital policies and procedures, the hospital failed to ensure that patients transferred to other facilities were accepted by the receiving facility and provider prior to leaving the hospital for 2 of 8 patients transferred (Patient #4, Patient #9).

Failure to ensure that patients have been accepted by the receiving facility and provider risks inappropriate transfer, delayed care, and poor patient outcomes.

Findings included:

1. Document review of the hospital's policy titled, "Transfer to Other Health Care Facilities," number 16544664, effective date 12/24, showed that an appropriate transfer is one in which:
a. The transferring hospital provides medical treatment within its capacity that minimizes the risks to the patient's health and, in the case of a patient in labor, the health of the unborn child;
b. The receiving facility has available space and qualified personnel for the treatment of the patient and has agreed to accept the transfer and provide appropriate medical treatment;
c. The transferring hospital provides the receiving facility with copies of all appropriate medical records of the examination and treatment performed. If test results or other records are not available at the time of transfer, they should be sent as soon as practical after the transfer;
d. The transporting personnel are qualified and the necessary transportation equipment for life support is also transported with the patient.

2. Medical record review showed that patient #4 presented to the Emergency Department (ED) on 01/02/25 via ambulance with complaints of right flank pain and abdominal pain for 4-6 weeks. The patient also complained of having a fever. A medical screening examination was conducted, including laboratory and radiology testing. Documentation showed that the ED provider spoke with multiple physicians to admit the patient. The hospital did not have urology coverage, so the patient was transferred to another hospital. Provider acceptance at the receiving facility was documented in the provider's notes, but there was no transfer form in the medical record.

3. Medical record review showed that patient #9 arrived in the ED on 12/24/24 via private vehicle and stated that they were having a bipolar manic episode. The patient stated that they had called and were accepted at a behavioral health facility, but they needed to go to the ED for medical clearance first. A medical screening examination was conducted including laboratory testing. The patient was medically cleared and discharged in stable condition. The provider's note did not show that there was an accepting provider at the receiving facility. The medical record did not include a transfer form.

4. During an interview with the investigator, the Chief Medical Officer (Staff #1) stated that that they were told about Patient #9 by a staff nurse, and conducted a medical record review and interviewed the involved provider. Staff #1 reported to the quality department that an EMTALA violation had occurred and that the violation needed to be reported.

5. During an interview with the investigator, the Accreditation Manager (Staff #2) stated that the EMTALA violation was reported to the quality department. The medical record was reviewed and the Washington State Department of Health was notified of the EMTALA violation.

ITEM #2 Transfer Documentation

Based on interview, document review, and review of hospital policies and procedures, patients transferred to other facilities did not have documentation on the Transfer Form as required by hospital policy for 2 of 8 patients transferred (Patient #4, Patient #9).

Failure to ensure that patients have completed documentation prior to transferring to another facility risks inappropriate transfer, delayed care, and poor outcomes.

Findings included:

1. Document review of the hospital's policy titled, "Transfer to Other Health Care Facilities," number 16544664, effective date 12/24, showed that the Emergency Department physician or the attending physician (if responsible for certifying a patient transfer) shall:
a. Ensure that an appropriate medical screening screening examination was performed for the patient in order to determine if an emergency medical condition exists
b. Certify on the Patient Transfer/Physician orders form that the benefit to the patient outweighs the risk of the transfer
c. Document on the Patient Transfer/Physician orders form the basis of the certification
d. Obtain informed consent for the transfer from the patient or legal representative
e. Contact the receiving physician to establish acceptance of the patient and document the name of the receiving physician and the time of acceptance on the Patient Transfer/Physician order form.

2. On 01/30/25, between 11:09 AM and 12:30 PM, medical record review was conducted with the Emergency Department Manager (Staff #3). Medical record review showed that there was no Patient Transfer/Physician order form or hospital transfer form located in 2 of 8 records of patients transferred to other facilities (Patient #4, Patient #9).

3. At the tine of the review, Staff #3 verified that there was no Patient Transfer/Physician order form or hospital transfer form located in the medical records for Patient #4 or Patient #9.

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