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Based on record review and interview, the hospital failed to maintain an accurate and complete Emergency Department Central (patient) Log on each individual who came to the Emergency Department as evidenced by failing to document in the central log a patient who came to the Emergency Department for 1 (#1) of 20 (#1-20) patients sampled.

Findings:

Review of the hospital's policy titled "Emergency Department Log" revealed in part, a central log on each individual who "comes to the Emergency Department" will be maintained. The purpose of the central log is to track the care provided to each individual who comes to the hospital seeking care for an emergency medical condition.

Review of the ED central log for the month of February 2023 failed to reveal Patient #1.

Video Review:
On 03/27/2023 at 2:03 p.m. hospital video revealed Patient #1 and a police officer walking through the emergency department entrance on 02/12/2023 at 3:38 p.m. Patient #1 and the police officer are seen walking to the front desk and speaking with S2GR. At 3:44 p.m. S3SW joins S2GR behind the desk and is seen talking with Patient #1 and the police officer. At 3:48 p.m. the police officer is seen walking out of the emergency department. At 3:52 p.m. Patient #1 and S3SW are seen walking away from the front desk out of the view of the camera going in different directions. At 4:12 p.m. Patient #1 is seen walking back to the front desk and at 4:18 p.m. S3SW is seen walking back to the front desk. At 4:19:06 p.m. Patient #1 is seen walking out of the emergency department. S3SW is seen walking out of the emergency department at 4:19:27 p.m. and back in at 4:20 p.m. In an interview during the video review, S3SW stated she walked out the emergency department to see if Patient #1 left. S3SW stated when she walked out of the emergency department, Patient #1 was already half way down the street.

In an interview on 03/27/2023 at 2:19 p.m. S3SW stated the police officer said Patient #1 was at a parade but he did not have a reason to keep Patient #1 and he did not want to leave Patient #1 on the street, so he brought Patient #1 to the emergency department. S3SW stated Patient #1 was able to tell S3SW her name and date of birth. S3SW stated she then looked up Patient #1 in the hospital's computer system. S3SW stated Patient #1 had a hospital visit on 05/05/2020. S3SW stated she then searched Patient #1's record to find contact information for Patient #1's family. S3SW stated she reviewed Patient #1's facesheet, discharge summary, and nursing progress notes. S3SW stated she only looked for contact information. S3SW stated she did not look at discharge diagnosis or anything like that. S3SW stated when reviewing the nursing progress notes, she was able to find a progress note that revealed Patient #1 was discharged to nursing home "a". S3SW stated she called nursing home "a" and asked if they had a patient by that name. S3SW stated nursing home "a" told her they did not have a resident by that name. S3SW stated nursing home "a" is located near the hospital on North St. S3SW stated nursing home "a" is the only nursing home she called. S3SW stated the police officer told her that the emergency department did not need to check in Patient #1. S3SW stated Patient #1 gave S3SW her daughter's name and phone numbers. S3SW stated she tried calling the numbers Patient #1 gave her but S3SW stated the phone numbers were not working numbers. S3SW also stated the phone numbers that were found in Patient #1's medical record (from a previous admission) were also not working numbers. S3SW stated Patient #1 kept saying "her house was by the store" over and over again. S3SW stated Patient #1 said the name of the store but S3SW stated she did not remember the name of the store.

In an interview on 03/27/2023 at 2:58 p.m. S2GR stated the police brought Patient #1 to the emergency department. S2GR stated the police told her that Patient #1 was at the Mardi Gras parade and for an unknown reason picked up Patient #1.S2GR stated the police said he had been riding around with Patient #1 trying to find where Patient #1 lived. S2GR stated the police said he then brought Patient #1 to the emergency department. S2GR stated Patient #1 kept saying she lived by the store. S2GR stated she could not remember the name of the store that Patient #1 said. S2GR stated Patient #1 said "she did not want to stay, she wanted to leave, and she stays by the store." S2GR stated Patient #1 seemed a little confused. S2GR stated S3SW called a nursing home near the hospital. S2GR stated she was not sure of what nursing home S3SW called. S2GR stated when Patient #1 arrived at the emergency department, Patient #1 kept smiling and then Patient #1 wanted to go home. S2GR stated she was working as the greeter on the day Patient #1 was brought to the emergency department. S2GR stated she checks patients in, takes vital signs, and brings patients to the back. S2GR stated she called the social worker to see what she needed to do with Patient #1. S2GR stated Patient #1 was not triaged, no vital signs were taken, and the nurses nor doctor assessed Patient #1.

In an interview on 03/28/2023 at 8:28 a.m. S1DR verified Patient #1 was not included in the emergency department's central log.

Based on record review and interviews, the hospital failed to provide a medical screening exam on all patients who presented to the emergency department for 1 (#1) of 20 (#1-20) patients sampled. This deficient practice is evidenced by Patient #1 presenting to the emergency department with a history of unspecified psychosis and major neurocognitive disorder and not receiving a medical screening exam.

Findings:

Review of the ED central log for the month of February 2023 failed to reveal Patient #1.

Review of Patient #1's discharge summary (from a previous visit at the hospital) dated 05/27/2020 revealed a discharge diagnosis of unspecified psychosis and major neurocognitive disorder.

Video Review:
On 03/27/2023 at 2:03 p.m. hospital video revealed Patient #1 and a police officer walking through the emergency department entrance on 02/12/2023 at 3:38 p.m. Patient #1 and the police officer are seen walking to the front desk and speaking with S2GR. At 3:44 p.m. S3SW joins S2GR behind the desk and is seen talking with Patient #1 and the police officer. At 3:48 p.m. the police officer is seen walking out of the emergency department. At 3:52 p.m. Patient #1 and S3SW are seen walking away from the front desk out of the view of the camera going in different directions. At 4:12 p.m. Patient #1 is seen walking back to the front desk and at 4:18 p.m. S3SW is seen walking back to the front desk. At 4:19:06 p.m. Patient #1 is seen walking out of the emergency department. S3SW is seen walking out of the emergency department at 4:19:27 p.m. and back in at 4:20 p.m. In an interview during the video review, S3SW stated she walked out the emergency department to see if Patient #1 left. S3SW stated when she walked out of the emergency department, Patient #1 was already half way down the street.

In an interview on 03/27/2023 at 2:19 p.m. S3SW stated the police officer said Patient #1 was at a parade but he did not have a reason to keep Patient #1 and he did not want to leave Patient #1 on the street, so he brought Patient #1 to the emergency department. S3SW stated Patient #1 was able to tell S3SW her name and date of birth. S3SW stated she then looked up Patient #1 in the hospital's computer system. S3SW stated Patient #1 had a hospital visit on 05/05/2020. S3SW stated she then searched Patient #1's record to find contact information for Patient #1's family. S3SW stated she reviewed Patient #1's facesheet, discharge summary, and nursing progress notes. S3SW stated she only looked for contact information. S3SW stated she did not look at discharge diagnosis or anything like that. S3SW stated when reviewing the nursing progress notes, she was able to find a progress note that revealed Patient #1 was discharged to nursing home "a". S3SW stated she called nursing home "a" and asked if they had a patient by that name. S3SW stated nursing home "a" told her they did not have a resident by that name. S3SW stated nursing home "a" is located near the hospital on North St. S3SW stated nursing home "a" is the only nursing home she called. S3SW stated the police officer told her that the emergency department did not need to check in Patient #1. S3SW stated Patient #1 gave S3SW her daughter's name and phone numbers. S3SW stated she tried calling the numbers Patient #1 gave her but S3SW stated the phone numbers were not working numbers. S3SW also stated the phone numbers that were found in Patient #1's medical record (from a previous admission) were also not working numbers. S3SW stated Patient #1 kept saying "her house was by the store" over and over again. S3SW stated Patient #1 said the name of the store but S3SW stated she did not remember the name of the store.

In an interview on 03/27/2023 at 2:58 p.m. S2GR stated the police brought Patient #1 to the emergency department. S2GR stated the police told her that Patient #1 was at the Mardi Gras parade and for an unknown reason picked up Patient #1.S2GR stated the police said he had been riding around with Patient #1 trying to find where Patient #1 lived. S2GR stated the police said he then brought Patient #1 to the emergency department. S2GR stated Patient #1 kept saying she lived by the store. S2GR stated she could not remember the name of the store that Patient #1 said. S2GR stated Patient #1 said "she did not want to stay, she wanted to leave, and she stays by the store." S2GR stated Patient #1 seemed a little confused. S2GR stated S3SW called a nursing home near the hospital. S2GR stated she was not sure of what nursing home S3SW called. S2GR stated when Patient #1 arrived at the emergency department, Patient #1 kept smiling and then Patient #1 wanted to go home. S2GR stated she was working as the greeter on the day Patient #1 was brought to the emergency department. S2GR stated she checks patients in, takes vital signs, and brings patients to the back. S2GR stated she called the social worker to see what she needed to do with Patient #1. S2GR stated Patient #1 was not triaged, no vital signs were taken, and the nurses nor doctor assessed Patient #1.

In an interview on 03/27/2023 at 3:10 p.m. S4CI stated there are two nursing homes on North St.; nursing home "a" and nursing home "b".

In an interview on 03/28/2023 at 8:28 a.m. S1DR verified Patient #1 was not triaged, was not seen by a physician, and was not provided a medical screening exam.

Review of the nursing home SIMS #87410 revealed Patient #1 had diagnoses that included dementia, paranoid schizophrenia, schizoaffective disorder-bipolar type, and cerebrovascular disease. Further review revealed Patient #1 was found on 02/12/2023 at 10:00 p.m. by an off duty staff member from nursing home "b". Patient #1 was located 1.7 miles away from the nursing home near a heavily traveled intersection. The nursing home reported Patient #1 had an abrasion to her nose and minimal swelling and discoloration to her upper lip. Patient #1 was unable to give a clear account for the nose injury.