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Based on record and policy review and staff interview it was determined that the facility failed to follow the policy relating to assessment of the patient being discharged from the Emergency Department (ED) for 2 (#1, #2) of 6 sampled patients. This practice does not ensure a safe and effective discharge and may cause a return visit to the ED.

Findings include:

1. Patient #2 presented to the ED at 11:00 p.m. on 1/3/11 following a fall. The patient was triaged as a level 3. An assessment was performed at 12:10 a.m. on 1/4/11. A safety assessment was documented at 2:23 a.m. on 1/4/11. The patient was discharged from the ED by the physician. At 3:26 a.m. on 1/4/11, the nurse documented that the spouse had been contacted but could not come to the hospital to take the patient home and that the patient could ride in a taxi. A note at 5:18 a.m. indicated the patient was discharged home. The note indicated the patient was in a wheelchair and was accompanied by a family member. There was no further documentation of vital signs or patient assessment.

Review of a second ED visit dated 1/4/11 revealed the patient was taken into the treatment area from the ED waiting area. He had not been discharged from the ED with a family member as documented in the prior record. The patient had been sitting in the ED waiting area for approximately 7 hours. The patient was found to be lethargic, confused and hypotensive.

The facility's policy "Reassessment of Patients" last reviewed 10/09, required that a patient triaged as non-urgent, which is a level 3 or higher, was to be reassessed including vital signs prior to discharge from the ED.

The Risk Manager was interviewed on 3/8/11 at approximately 11:00 a.m. She presented a written statement from the staff person who was on duty in the reception area on the morning of 1/4/11. She documented that she noticed the patient sitting in a wheelchair when she came on duty at 6:10 a.m. The patient was asleep as she approached him. The patient told her he was waiting for a ride home. She noted that no one from the night shift had reported to her there was a patient in the waiting room, waiting for a ride home. The Risk Manager confirmed that the nurse failed to provide accurate documentation of the discharge from the ED treatment area. She also confirmed that the nurse failed to follow facility policy on ED discharges and the actions were not appropriate for the patient.

A staff nurse in the ED was interviewed on 3/8/11 at approximately 3:00 a.m. The scenario was presented to her. She stated that she would have kept the patient in the ED until safe transport for the patient was verified.


2. Patient #1 presented to the ED on 1/15/11 at 9:24 a.m. He was triaged as a level 3. The patient was sent from a long term care facility with the chief complaint of weakness. Vitals signs were recorded at 12:32 p.m. and 2:09 p.m. A note written at 2:15 p.m. indicated the transferring facility could not provide transport back to the facility until 3:30 p.m. There was no documented assessment or vital signs recorded after that time. A note on the discharge instructions indicated the patient was taken by a staff member from the long term care facility at 3:50 p.m.

The Director of Regulatory Compliance confirmed there was no assessment or vital signs prior to the patient's discharge.