HospitalInspections.org

Based on interview and record review the facility failed to ensure patient #33's second ED visit on the same day was documented in the hospital's ED log. This failed action created an inaccurate record of patients presenting to the ED seeking medical treatment. Findings.


During an interview on 8/21/14 at 4:00 pm the Director of Patient Safety and Regulatory Compliance stated Patient #33 had not been added to the ED log after returning for a second visit on 8/15/14. The Patient had been examined by the physician in the sally port.


Review of the ED log revealed Patient #33's first visit was documented in the ED log on 8/15/14 at 6:48 am, but there was no documentation of the Patient's second visit to the ED on the same day.

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Based on record review and interview the facility failed to ensure: 1) 2 patients (#s 1 and 9) who presented to the Emergency Department were provided with medical screening exams by a qualified provider to determine if the individuals had an emergency medical condition prior to being sent to the Obstetrics triage (an area used for determining patient priority located in the OB unit, in another part of the hospital) and 2)1 patient (#33) who presented to the Psychiatric Emergency Department in the salley port (a triage area outside the PED located in the garage area where police and ambulances bring patients to the PED), was provided with a medical screening exam by a qualified provider to determine if the individual had an emergency medical condition. This failed practice placed all patients who presented to the Emergency Department or the Psychiatric Emergency Department at risk for not receiving a medical screening exam by a qualified provider. Findings:

OB Patients Presented to the ED
Patient #1
Review of the medical record revealed the Patient presented to the ED on 8/20/14 at 11:12 am for "Decreased Fetal Movement". The Patient was taken immediately to the OB triage area and not seen in the emergency department. There was no documented ED medical screening exam done. The medical record revealed the Patient was discharged home from the OB unit.

Patient #9
Review of the medical record revealed the Patient presented to the ED on 3/17/14 at 6:18 pm for "Abdominal Pain". The Patient was approximately 20 weeks pregnant. The Patient was sent to the OB triage area at 6:22 pm. There was no documentation that a medical screening exam was done. The medical record revealed the Patient was discharged to home from the OB unit at 10:23 pm.

During an interview on 8/21/14 at 12:15 pm, the OB Director stated the OB triage does not do medical screening exams. She further stated that anything medical would go through the ED. She was asked if a pregnant woman presented to the ED with abdominal pain would that be medical. She said, "Yes". She continued to say that a pregnant woman who would present to the ED would be assessed by the triage nurse in the ED and the nurse would determine if there was a medical condition. They would not get a medical screening exam if they were sent directly to the OB triage.

During an interview on 8/21/14 at 1:00 pm, the Director of Patient Safety & Regulatory Compliance was asked if the nurse in the ED can make the decision to send patients from the ED to the OB triage. He said the triage nurse could not.

During an interview on 8/21/14 at 2:00 pm, the Executive Director of the OB department stated the OB triage and the ED were separate departments.

Patient Who Presented to the Psychiatric Emergency Salley Port
Patient #33
The facility self-reported Patient #33 who presented to the PED salley port on 8/15/14 accompanied by police. The police officer reported "the patient had expressed suicidal ideation by means drinking antifreeze." Physician #2 and Psychiatric Clinician #1 met the police officer and the Patient in the salley port. The Patient was not taken into the PED at any time. There was no documentation that a medical screening exam was done.

During a phone interview on 8/29/14 at 9:26 am, the Director of Patient Safety & Regulatory Compliance confirmed Physician #2 saw Patient #33 in the salley port and there was no documention that any medical screening exam was done. He stated there was no documentation of the Patient's visit because the Patient had not been registered for the visit. He further said the police had driven Patient #33 to a different hospital and was admitted, after they left Providence Alaska Medical Center.

Review of the facility's "Welcome Psychiatric Emergency Department at Providence" revealed "...An Emergency Medicine Physician will provide you with a brief medical assessment..."

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Based on record review and interview the facility failed to ensure 1 patient (#3), who was seen in the Emergency Department had documentation of: 1) a requested transfer to another hospital and 2) that the patient was aware of the risk and benefits of being transferred to another hospital for care. This failed practice denied the patient the right to make an informed decision regarding the transfer to another hospital. Findings:

Patient #3

Record review on 8/21/14 revealed the Patient presented to the ED on 3/14/14 at 10:20 am with a diagnosis of vaginal bleeding. The Patient was examined and treated at the ED until her discharge at 5:53 pm when she was transferred to another local hospital. Her diagnosis at the time of transfer was "vaginal bleeding" and "retained products of conception". The ED medical record contained no documentation the the Patient requested being transferred to another hospital or that the Patient was told about the risks and benefits of being transferred.

During an interview on 8/21/14 at 1:20 pm, the Director of Patient Safety & Regulatory Compliance stated there was no more documentation of the ED medical record for Patient #3s 3/14/14 visit.

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Based on interview and record review the facility self-reported to the State Agency that 1 physician (Physician #1) failed to accept an appropriate transfer of 1 patient referred from a transferring hospital on 8/12/14. This failed practice caused the patient, from the transferring hospital, to be air transported to a recipient hospital out of state which resulted in delay of care for the patient. Findings:

During the survey, 8/20-21/14, the Director of Patient Safety & Regulatory Compliance discussed with the Surveyors Physician #1's refusal to accept a patient from a transferring hospital on 8/12/14, when the physician was on-call and the patient's health issues were within the physician's specialty.

During an interview on 8/21/14 at 4:30 pm, the Director of Patient Safety & Regulatory Compliance confirmed Physician #1 was credentialed and was an active member of the medical staff. In addition, during the credentialing paperwork review, he confirmed the physician had signed the following: "Reappointment Application for Medical Staff or Advance Practice Professionals" which revealed, "I agree to provide for continuous care of my patients and may be required to take Emergency Room Call in my specialty."

Review of the medical staff bylaws, dated 5/21/13, revealed "ACTIVE STAFF...Responsibilities...participate in Emergency Call..."

Review of the most recent facility policy "CALL COVERAGE REQUIREMENTS Number: MS 920-010", review date 8/13, revealed, "...PHYSICIAN" ON CALL"RESPONSIBILITIES...the on-call physician, if requested must come to the ED...the on-call physician must come when requested to do so by one of the following after ascertaining the problem is within the physician's scope of care: a. the ED physician..."

Review of the most recent facility policy "PHYSICIAN RESPONSIBILITIES TO PROVIDE PROMPT & PROPER CARE TO ALL PATIENTS Number MS 920-030", revised date 6/11, revealed, "PURPOSE/SCOPE...To ensure each member of the Providence Alaska Medical Center's Medical Staff who is required to take EMTALA Call responds to that call in a timely manner when called, and to ensure compliance with federal EMTALA regulations..."ON CALL" PHYSICIAN RESPONSIBILITIES ON EMTALA DEFINED PATIENTS The on-call Physician must come to the ED when called: 1. The on-call physician must come to the ED when requested to do so by one of the following: a. the ED physician...DISPUTES OVER NEED TO RESPOND 1. If the on-call physician disagrees about the need to come to the ED, the on-call physician must come to the hospital and render care irrespective of the disagreement..."

During an interview on 8/21/14 at 3:40 pm, the CEO stated Physician #1 should have accepted the Patient from the transferring hospital.