HospitalInspections.org

.
Based on interview and review of documents and policies and procedures, the facility failed to ensure compliance to EMTALA regulations, CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases.

Failure to do so created risk for a adverse patient outcome(s) and harm in the delivery of emergency services.

Findings:

As detailed in Tag 2405 it was determined that the hospital failed to adequately develop and implement policies and procedures pertaining to maintenance of patient emergency logs for the main emergency department and the obstetrical emergency department, and therefore failed to comply with CFR §489.24.

.
Based on record review and interview, the facility failed to demonstrate that it developed and maintained a central log of ED obstetrical (OB) and main emergency department (ED) patients that included required information.

Failure to develop and maintain a central log created risk that problems with care delivery of ED services to OB and non-OB patients would not be identified and adequately addressed which may result in patient harm.

Findings included:

1. a. Record review of facility policy titled, "Emergency Medical Treatment & Labor Act (EMTALA)," #1750122, revised 09/09/2015, discussed the maintenance of central logs of individuals seeking emergency care in the hospital [main] Emergency Department and Family Birth Center (obstetrical care). The log information included maintenance about whether the individual refused treatment; denied treatment; were treated, admitted, stabilized and/or transferred or discharged. There was no further explanation about recording disposition status based on the other levels of patient care.

b. Review of facility policy titled, "Obstetric Emergency Department Triage," #5051878, revised 0/14/2018 stated that log record of "triage" patients must include patient name, date, time of arrival, and chief complaint." There was no further explanation about recording disposition status based on the other levels of patient care.

2. a. Review of facility central logs for patients who presented for care to the main ED showed, in the disposition section, the record did not contain entries for whether patients had been "stabilized and transferred"; and "stabilized or transferred". There were entries about general "transfer" status. Additionally, there were not entries specific to "denied" treatment and received "treatment," including for patients being discharged.

b. Review of the facility central logs for patients who presented for care to the OB-ED area showed that the same omissions for record of patient disposition status.

3. a. On 08/08/19 at 10:00 AM, the investigator interviewed a staff nurse in OB-ED area (Staff #1). When asked about patient status (different definitions) and data gathering in the OB log, she was not familiar with the definitions and requirements of the log besides what was noted in the facility OB procedure.

b. On 08/08/19 at 2:00 PM, the investigator discussed the content of the ED log entries with the Survey Support Manager (Staff #2). She acknowledged that information entries were not consistent with maintenance described in facility policy and procedure.
.