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Based on record review and interview, the facility failed to follow triage policies for 1 (#9) of 1 patients with an emergency acuity level of 2 (ESI 2), resulting in the potential for less than optimal outcomes. Findings include:

Record review with the Emergency Center Nurse Director (Staff E) revealed that patient #9 was a 38-year-old male who had presented to the emergency center (EC) by car on 9/12/24 at 2146 with altered mental status. He was assessed (vital signs and questions) by the triage nurse at 2148 and assigned an acuity or emergency severity index (ESI) of 2 (a triage level assigned to patients who need emergency care and should be seen by a physician promptly). On 9/13/24 at 0104 (three hours and 16 minutes later), the patient was called back to an EC room, but had left without being seen by a physician or provider.

On 10/16/24 at 1330, phone interview with the Triage Nurse (Staff Q), who worked on the date and time of the occurrence, revealed that she did not recall the patient. After review of her notes, Triage Nurse Q stated that on that evening they were very busy, the patient was younger, was stable, and that there were sicker patients in the EC. When the Triage Nurse was queried about additional assessments or vital signs, she stated that was done in the back when the patient was placed in an EC room. Interview with the EC Nursing Director E, on 10/16/24 at approximately 1400, verified that reassessment with vital signs should have been done after two hours by the triage nurse.

Review of the EC policy and procedure titled "Assessment Standards For Nursing: Emergency Services, dated 7/19/24" documented, "Nursing Reassessment ESI level 1 & 2: Minimally every 1-hour while patient unstable (refer to ESI criteria), then every 2 hours once the patient's acuity becomes more stable based on ESI level criteria." This had not been done.

Based on observation and interview, the facility failed to post Emergency Medical Treatment and Labor Act (EMTALA) signs in areas likely to be noticed by all individuals waiting for examination and treatment in the emergency center (EC), resulting in the potential for all EC patients to not be informed of their rights to have a medical screening exam and stabilizing treatment. Findings include:

During the observational tour of the EC, on 10/15/24 at approximately 1030 - 1200, it was noted that there was only one EMTALA sign to the left and below eye level right next to the patient walk-in doorway and one sign in the ambulance entrance. The EC was a large 144 room facility with four triage rooms and a large waiting area. These signs were not visible to patients waiting for examination or treatment. There were no signs posted in the Waiting Area, none in the Triage Rooms, and none in the Treatment Rooms/Areas.

On 10/15/24 at approximately 1120, EC Nurse Director E was queried about the lack of EMTALA signs and she stated that they only had EMTALA signs at the emergency entrances.