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Based on document review and staff interview, it was determined that the Hospital failed to ensure compliance with 42 CFR 489.24.

Findings include:

1. The Hospital failed to ensure that all patients who came to the Emergency Department (ED) were provided an appropriate medical screening examination. (A-2406)

2. The Hospital failed to complete the transfer form and obtain written consent for transfer from the patient and/or family member was obtained prior to transfer to another Hospital. (A-2409)

Based on document review and staff interview, it was determined that in 5 of 20 (Pt #2 Pt #3, Pt #4, Pt #5 and Pt #15) Emergency Department (ED) records reviewed, the Hospital failed to ensure that all patients who came to the Emergency Department (ED) were provided an appropriate medical screening examination.

Findings include:

1. On 07/19/2022 at approximately 1:30 PM, Pt #2's record was reviewed. Pt #2 presented to the Free-Standing Emergency Care (FEC) on 6/19/22 at 5:41 PM. Pt #2's chief complaint was chest pain. The record lacked a triage assessment indicating the Emergency Severity Index score. The record stated Pt #2 left without being seen (LWBS) at 6:23 PM. The record lacked a Medical Screening Exam.

2. On 07/19/2022 at approximately 2:00 PM, Pt #3's record was reviewed. Pt #3's record stated Pt #3 presented to the FEC on 6/19/2022 at 2:36 PM with a chief complaint of headache. Pt #3 had a nursing triage assessment completed at 2:55 PM which indicated Pt #3's headache was rated a 10 out of 10 in pain. The assessment indicated an ESI score of 3. The record stated Pt #3 left without being seen at 6:34 PM. The record lacked a MSE.

3. On 07/19/2022 at approximately 2:15 PM Pt #4's record was reviewed. Pt #4's record stated Pt #4 presented to the FEC on 6/27/2022 at 7:14 PM with a chief complaint of palpitations (feeling of heart beating fast). Pt #4 had a nursing triage assessment completed at 7:23 PM which indicated an ESI of 3. The record stated Pt #4 left without being seen at 10:02 PM. The record lacked a MSE.

4. On 07/19/2022 at approximately 2:25 PM, Pt #5's record was reviewed. Pt #5's stated Pt #5 presented to the FEC with a chief complaint of abdominal pain. Pt #5 had a nursing triage assessment completed at 4:38 PM which incicated an ESI score of 3 . The record stated Pt #5 left without being seen at 7:10 PM. The record lacked a MSE.

5. On 7/21/2022 at approximately 10:20 AM, Pt #15's record was reviewed. Pt #15's record stated Pt #15 presented to the ED with a chief complaint of abdominal pain. Pt #15's triage time was 3:34 AM. The record lacked a MSE. The record stated Pt #15 left without being seen at 8:16 AM.

6. During the record reviews, an interview was conducted with the Quality Improvement RN ED (E #5). E #2 confirmed the above findings and agreed the records lacked indication why the patients left.

7. On 07/21/22 at 8:45 AM the policy, "Emergency Medical Treatment and Labor Act (EMTALA) and Medical Screen Examination (revised 01/14/22)" was reviewed. The policy stated " ... Policy: 1. Silver Cross Hospital and the Free-Standing Emergency Department complies with all EMTALA obligations as follows: .... C. Each emergency department provides and appropriate Medical Screening Examination (MSE) to determine whether an Emergency Medical Condition (EMC) exists to any patient who 'comes to the emergency department (ED)' 2. The Medical Screening Examination - An individual who comes to the hospital emergency department is offered an MSE ..."

Based on document review and interview, it was determined that for 1 of 4 (Pt. #6), clinical records reviewed for transfer, the Hospital failed tocomplete the transfer form and obtain consent prior to transfer.

Findings include:

1. On 07/19/2022 at approximately 2:45 PM, Pt #6's record was reviewed. Pt #6 presented to the Free-Standing Emergency Care on 7/1/2022 at 1:02 PM, with a chief complaint of hernia pain and constipation. Pt #6's medical screening examination was done at 2:45 PM. Pt. #6 was transferred to surgery at the main hospital for incarcerated hernia and small bowel obstruction at 4:40 PM. Pt. #6's "Consent and Physician Certificate for Inter-Hospital Transfer form was incomplete. The form did not indicate if the patient had been stabilized, did not indicate the reason for transfer, lacked the patient/legal representative informed consent/signature, did not indicate which receiving facility the patient was transferring to and did not indicate the accepting physician. The record lacked any nurse to nurse communication for the acceptance of the patient.

2. On 07/19/2022 at approximately 2:55 PM, an interview was conducted with the Quality Improvement RN ED (E #5). E #2 reviewed the record and stated, "The transfer form should have been completed and signed by the patient or patient representative and it was not."

3. On 07/21/22 at 8:45 AM the policy, "Emergency Medical Treatment and Labor Act (EMTALA) and Medical Screen Examination (revised 01/14/22)" was reviewed. The policy stated " ... 4. A transfer of an unstable patient with an EMC (e.g. ... severe digestive symptoms ...) to another medical facility capable of providing the patient with the necessary stabilizing treatment may be made in the following circumstances: ... A physician has signed a certification that the medical benefits of the transfer are expected to outweigh the risks of transfer. The certification will state the reason for transfer, patient condition, benefit/risks of transfer, receiving hospital, mode of transportation, and patient consent."