HospitalInspections.org

Based on record review and interview, for one (Patient #10) of thirty patients sampled, Hospital #1 failed to provide an appropriate Medical Screening Examination (MSE) within the capability of the hospital's Emergency Department to determine whether or not an emergency medical condition exists.

Findings include:

Hospital #1's Emergency Medical Treatment and Active Labor Act (EMTALA) Policy, dated 2/16/15, indicated that every patient regardless of ability to pay, who presents on Hospital property and requests examination or treatment of a potential Emergency Medical Condition (EMC) shall receive an appropriate MSE to determine whether the patient is experiencing an EMC. If it is determined that the patient is experiencing an EMC, the hospital shall either stabilize the EMC within the capability of the hospital or transfer to another medical facility in accordance with the provisions of the EMTALA (and this policy).

The Surveyor interviewed the Clinical Resource Nurse (CRN) on 4/19/18 at 11:55 A.M. The CRN said that on 4/6/18, during her 3:00 P.M.-11:00 P.M. shift, she was contacted to care for Patient #30 that arrived with a suspected ST Elevation Myocardial Infarction (STEMI-a heart attack) in the Emergency Department (ED). The CRN said that Patient #30 was prepared for transfer to the Cardiac Catheterization Lab (Cath Lab) for treatment. The CRN said that as Patient #30 was being prepared for transfer, the ED was notified that a second patient (Patient #10) with a STEMI was enroute. The CRN said that there was only one Cath Lab available in the facility. The CRN said that as the ED staff were contacting Hospital #2 about their Cath Lab availability, Patient #10 arrived. The CRN said that Emergency Medical Services (EMS) had obtained two electrocardiograms (EKG) during transport. The CRN said that the ED physician looked at the EKGs and vital signs and noted that the second EKG had improved. The CRN said that Patient #10 was then sent to Hospital #2 by the ED physician. The CRN said that moments later, the ED physician realized that Hospital #2 did not have coverage for their Cath Lab. The CRN said that the ED Physician notified the Chief of Emergency Medicine immediately. The CRN said that she then went to the Cath Lab with Patient #30.

The Surveyor interviewed the Chief of Emergency Medicine on 4/19/18 at 1:37 P.M. The Chief of Emergency Medicine said that he was notified of the incident on the evening of 4/06/18. The Chief of Emergency Medicine said he was made aware that a patient (Patient #30) was diagnosed with a STEMI and was sent to the Cath Lab for treatment. The Chief of Emergency Medicine said that he was also notified that a second patient (Patient #10) arrived at the hospital with a suspected STEMI. The Chief of Emergency Medicine said that Patient #10 was quickly sent to Hospital #2 and shortly after transfer the ED physician learned that Hospital #2's Cath Lab was unavailable. The Chief of Emergency Medicine said that Patient #10 was then transferred to Hospital #3, from Hospital #2, where a Cath Lab was available.

The Surveyor interviewed the Chief Medical Officer (CMO) on 4/19/18, at 1:55 P.M. The CMO said that on 4/6/18, the attending ED physician had received a call from EMS about a a patient with a suspected STEMI en route to the hospital. The CMO said the ED attending attempted to notify EMS through Central Medical Emergency Dispatch (CMED) to divert the patient (Patient #10) to another hospital due to the Cath Lab being in use. The CMO said that by the time the ambulance was notified by CMED, they had already arrived in the ED. The CMO said in an attempt to have Patient #10 treated as quickly as possible, the ED attending met the ambulance crew and transferred Patient #10 patient to Hospital #2 so Patient #10 could be sent to Hospital #2's Cath Lab if necessary. The CMO said that shortly after Patient #10 was transferred the ED attending learned that the Cardiac Interventionist was covering both facilities and would not be available for Hospital #2's Cath Lab because he was already at Hospital #1 preparing for the first STEMI patient (Patient #30).

The Surveyor interviewed the ED Attending Physician on 4/19/18 at 4:15 P.M. The ED Attending Physician said that, on 4/6/18 while working in the ED, she was notified that a patient with a reported STEMI was being transported to the ED via EMS. The ED Attending Physician said that the Cath Lab was already in use so she attempted to contact the ambulance via CMED to divert them to another hospital for treatment. The ambulance arrived in the ED as CMED was notifying the ambulance. The ED Attending Physician said she did not bring the patient (Patient #10) into the ED to complete the required authorization for transport of a patient with an EMC. The ED Attending Physician said she met the EMS team and determined that Patient #10 was stable and transferred Patient #10 to Hospital #2. The ED Attending Physician said after Patient #10 was transferred she learned that Hospital #2's Cath Lab was not available. The ED attending physician said that she notified the Chief of Emergency Medicine and then notified Hospital #3 who accepted Patient #10 for treatment. The ED Attending Physician said that she should have brought Patient #10 into the ED, performed and documented a medical exam, and then completed the required authorization for transport of an EMC as required. The ED Attending Physician said that she did not perform these steps.

Based on record review and interview, for one (Patient #10) of thirty patients sampled, Hospital #1 failed to have completed and signed certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual.

Findings include:

The Hospital's Policy and Procedure titled Emergency Medical Treatment and Active Labor Act, dated 7/22/16, indicated that the certification for transfer must be completed and signed by a qualified medical provider.

Patient #10's Emergency Department (ED) Record dated 4/6/18, indicated there was not an authorization for transfer form completed by the ED Attending that examined Patient #10.

The Surveyor interviewed the ED Attending Physician on 4/19/18 at 4:15 P.M. The ED Attending Physician said that, on 4/6/18 while working in the ED, she was notified that a patient with a reported ST Elevation Myocardial Infarction (STEMI) was being transported to the ED via Emergency Medical Services (EMS). The ED Attending Physician said that the Cardiac Catheterization Lab (Cath Lab) was already in use so she attempted to contact the ambulance via CMED to divert them to another hospital for treatment. The ambulance arrived in the ED as Central Medical Emergency Dispatch (CMED) was notifying the ambulance. The ED Attending Physician said she did not bring the patient (Patient #10) into the ED to complete the required authorization for transport of a patient with an Emergency Medical Condition (EMC). The ED Attending Physician said she met the EMS team and determined that Patient #10 was stable and transferred Patient #10 to Hospital #2. The ED Attending Physician said after Patient #10 was transferred she learned that Hospital #2's Cath Lab was not available. The ED attending physician said that she notified the Chief of Emergency Medicine and then notified Hospital #3 who accepted Patient #10 for treatment. The ED Attending Physician said that she should have brought Patient #10 into the ED, performed and documented a Medical Screening Exam and then completed the required authorization for transport of an EMC as required. The ED Attending Physician said that she did not perform these steps.