HospitalInspections.org

Based on record review and interviews, the hospital failed to ensure an appropriate medical screening examination was conducted for patients presenting to the ED requesting for an examination of a medical condition for 1 patient (Patient #21) of 20 patient records reviewed (no documentation of Patient #21 visit on 03/27/21 was provided.)

This failed practice had the potential to cause Patient #21 to give birth without medical assistance in an unsafe environment.


Findings:

Policies and Procedures

A policy titled "Scope of Service" stated in part, "The patient population served by the Emergency Department consist [sic] of newborn, pediatric, adolescent, adult and geriatric patients requiring or seeking medical care...All patients that present to (facility name) premises for a nonscheduled visit and are seeking care shall receive a medical screening exam by an Emergency Department Physician/Provider..."


A policy titled "Protocols for High Acuity/Priority Emergency Department Patients" stated in part, "The RN MUST (facility's emphasis) complete a rapid baseline primary survey...Nurse staff need to obtain vital signs, apply cardiac monitor..."


A policy titled "COBRA and EMTALA Guidelines" stated in part, "All patients shall receive a medical screening exam in accordance with COBRA and EMTALA laws and requirements...The hospital must perform an MSE to determine if an EMC exists. It is not appropriate to merely 'log in' or triage an individual with a medical condition and not provide an MSE. Triage is not equivalent to an MSE."


Interviews

1. During an interview on 04/13/21 at 4:30 PM, Patient #21 reported that she called the facility and told the nurse she was coming to the hospital in labor. When she arrived at the facility on 03/27/21, 4 staff members were outside the hospital with a wheelchair. She reported that the provider asked if she thought she could go to another facility approximately 15 miles away to deliver her baby as the facility "was not prepared to deliver a baby." Patient #21 was informed that the hospital only had one ambulance and no infant warmer, and going to the other facility would be preferable. She stated she did not want to argue with them, and proceeded to travel to another facility by private vehicle.


2. During an interview on 04/15/21, Staff C verified that Patient #21 was met in the parking lot by the provider, RN, and CNA on 03/27/21. Staff C reported that the provider asked the patient some questions about her current pregnancy and past deliveries, and suggested that she proceed to a different facility. Staff C stated, "we know that they should not have sent the patient in labor on to (other facility)."


3. During an interview on 04/16/21, Staff E reported that when a patient comes to the ED, they are taken to a room and a staff member begins the registration process while the RN conducts an assessment. The RN then contacts the provider if not on site. The surveyor asked under what situation or circumstance a patient presenting to the ED would not receive an MSE, Staff E stated all patients get an MSE.


4. During an interview on 04/16/21, Staff F verified that Patient #21 was outside the hospital in her car when the provider spoke with her. Staff F reported that the provider asked if her water had broken or if she felt she needed to push, the patient denied both. Staff F reported that the patient was told, since her obstetrician was located at the suggested facility and they had the proper equipment, she should go there. The surveyor asked under what situation or circumstance a patient presenting to the ED would not receive an MSE, Staff F stated, there are none and Patient #21 "chose to go" to the other facility.


5. During an interview on 04/16/21, Staff G reported when a patient comes to the ED, they are taken to a room and the patient is registered while the RN is conducting an assessment. The RN then contacts the provider with the findings. Staff G verified that Patient #21 did not enter the hospital and the provider suggested she stay in the car and drive to a different facility. The surveyor asked under what situation or circumstance a patient presenting to the ED would not get an MSE, Staff G reported all patients receive an MSE.


6. During an interview 04/16/21, Staff I reported the facility does not have OB services and the only births at the hospital would be in the ED. Staff I stated Patient #21 informed them her water had not broken and she did not feel the need to push. Staff I stated, he/she felt the patient would be better served by the facility her obstetrician was with and the patient "chose to go" to the other facility. The surveyor asked under what situation or circumstance a patient presenting to the ED would not receive an MSE, Staff I stated patients are "typically checked in and examined".


7. When Patient #21 arrived at the second hospital, she was in virtually complete cervical dilation, infant station minus 2, and actively contracting.