HospitalInspections.org

Based on observation and staff interview conducted on 6/1/16, it was determined that the facility failed to conspicuously post signage, specifying the rights of individuals under section 1866 of the Act with respect to examination and treatment of emergency medical conditions and women in labor.

Findings include:

1. Observation of the ED main entrance waiting room/ lobby, revealed two (2) signs posted in an area that is not visible from where patients are seated. The signs were not conspicuously posted and the font was small, making visualization difficult.

2. Observation of the Triage Room revealed no signage posted.

3. Observation of the Family Waiting Room revealed no signage posted.

4. Observation of the eighteen (18) ED Treatment Rooms revealed no signage posted.

5. Observation of the Fast Track rooms revealed no signage posted.

6. Observation of the two (2) Nurse's Stations revealed no signage posted.

7. Staff #1 and Staff #2 confirmed the above findings.

Based on a review of the ED on-call schedule and staff interview, it was determined that the facility failed to ensure that the physician on-call lists identify an individual physician's name for each specialty on call.

Findings include:

1. A review of the on-call list for the Orthopedic service revealed that the name of a physician group was listed as on call from March 1, 2015 through December 31, 2015 and June 1, 2016 through June 30, 2016.

a. A specific Orthopedic physician's name was not listed.

2. A review of the on-call list for the Medicine service revealed that two (2) physician names were listed on call from March 1, 2015 through March 23, 2015, April 1, 2015 through April 23, 2015, April 25, 2015 through June 26, 2015, June 29, 2015 through August 30, 2015. September 1, 2015 through September 26, 2015, September 29, 2015 through October 13, 2015, October 20, 2015 through October 30, 2015 and November 1, 2015 through June 24, 2016.

a. A specific Medicine Physician's name was not listed.

3. A review of the on-call list for the Medicine service revealed that there are open slots with no physician on-call coverage from March 24, 2015 through March 31, 2015, April 24, 2015, June 27, 2015 through June 28, 2015, June 27 ,2016 through June 30, 2016, the day shifts of June 25 2015 and June 26, 2015,the night shifts of August 31, 2015,September 27, 2015, September 28, 2015, October 14, 2015, October , 15, 2015, October 16, 2015, October 17, 2015, October 18, 2015, October 19, 2015 and October 31, 2015.

a. A specific physician's name for Medicine was not listed.

4. A review of the on-call list for the Urology service revealed that there are open slots with no physician coverage listed on call from December 30, 2015 through January 3, 2016, and April 1, 2016 through April 10, 2016.

a. A specific physician's name for Urology was not listed.

5. A review of the on-call list for the Ophthalmology service revealed that there are open slots with no physician coverage listed on call from March 2, 2015 through March 8, 2015, March 23, 2015 through March 29, 2015, April 1, 2015 through April 5, 2015, April 13, 2015 through April 19, 2015, May 4, 2015 through May 7, 2015, May 15, 2015 through May 17, 2015, May 25, 2015 through May 31, 2015, June 15, 2015 through June 21, 2015, June 29, 2015 through July 5, 2015, July 27, 2015 through August 2, 2015, August 17, 2015 through August 23, 2015, September 7, 2015 through September 13, 2015, September 28, 2015 through October 4, 2015, October 19, 2015 through October 25, 2015, November 2, 2015 through November 8, 2015, November 30, 2015 through December 6, 2015, December 21, 2015 through December 27, 2015, January 11, 2016 through January 17, 2016, February 1, 2016 through February 8, 2016, February 22, 2016 through February 27, 2016, March 14, 2016 through March 20, 2016, April 4, 2016 through April 10, 2016, April 13,2016 and April 14, 2016, April 25, 2016 through May 1, 2016, May 16, 2016 through May 22, 2016, June 6, 2016 through June 12, 2016, and June 20, 2016 through June 26, 2016.

a. A specific physician's name for Ophthalmology was not listed.

6. A review of the on-call list for the ENT service revealed that there are open slots with no physician coverage listed on call from July 7, 2015 through July 17, 2015.

a. A specific physician's name for ENT was not listed.

7. A review of the on-call list for the GI service revealed that there are open slots with no physician coverage listed on call for the day shift from May 18, 2015 and May 19, 2015, and December 17, 2015 and December 18, 2015.

a. A specific physician's name for GI was not listed.

8. The above was confirmed by Staff #6.

Based on a review of the ED Log, medical records and staff interview, it was determined that not all log entries are accurate.

Findings include:

1. Documentation in Medical Record #7 states the disposition of the patient as "AMA" (Against Medical Advice). Documentation on the ED log states the disposition of the patient as "LWOT" (Left without treatment).

2. Documentation in Medical Record #28 states the disposition of the patient as "AMA." Documentation on the ED log states the disposition of the patient as "LWOT."

3. Documentation in Medical Record #29 states the disposition of the patient as "AMA." Documentation on the ED log states the disposition of the patient as "LWOT."

4. The above findings were confirmed by Staff #6.

Based on medical record review and staff interview, it was determined that the facility failed to provide an appropriate medical screening exam to all patients presenting to the ED.

Findings include:

1. Documentation on the ED log, dated 3/28/15 at 18:49, indicates that Patient #1 presented with "Sore throat, chest pain, shoulder pain."

2. Documentation in Medical Record #1-A revealed the following:

a. Documentation on the nursing triage note at 19:03 indicates, "Presenting complaint: Patient states: When I woke up this morning it hurt to breathe and there's pain in my chest and throat and across the back of my shoulders and they feel locked up and all drawn up."

b. Documentation on the nursing Triage Assessment note at 19:05 indicates, "Pain: Complaints of pain in chest, anterior aspect of right shoulder, posterior aspect of right shoulder, anterior aspect of left shoulder, posterior aspect of left shoulder and posterior chest Pain currently is 7 out of 10 on a pain scale. Quality of pain is described as sharp, tightness in chest ..."

c. There was no documentation in Medical Record #1-A of an EKG, labs being drawn, or chest X-Ray being completed on this patient to rule out cardiac or respiratory issues.

3. Documentation on the ED log, dated 4/1/15 at 15:35, indicates that Patient #1 presented with an "Abnormal EKG". The patient was sent from her primary care physician.

4. Documentation in Medical Record #1-B revealed the following:

a. Documentation on the nursing triage note at 16:00 indicates, "Presenting complaint: Patient states: I had an abnormal EKG at Dr. (name of physician) office so he sent me here. I was here before and they told me it was anxiety and panic attacks ..."

b. An EKG was completed at 16:25 and a CT scan completed at 18:20. Labs were drawn at 18:57. EKG: "Borderline low voltage in front leads and Borderline R wave progression, anterior leads. Labs: "CPK=164 (normal 30-135) and Troponin 1=5.26 (normal 0.00-0.05). The patient was admitted to telemetry and then transferred to another facility for a cardiac catheterization.

c. The above was confirmed by Staff #2.

Based on Medical Record review and staff interview, it was determined that the facility failed to ensure a transfer form is completed for all patients that are transferred to another facility.

Findings include:

1. Review of Medical Record #5 revealed the following:

a. The patient presented to the ED on 2/1/15 at 16:22 with a complaint of psychiatric problems.

b. Documentation in the medical record indicates the patient was medically cleared and a psychiatric evaluation was completed.

c. Documentation indicated the patient was in need of continued psychiatric care and was transferred to a psychiatric hospital.

d. There was no transfer form in the medical record.

2. The above was confirmed by Staff #6.