HospitalInspections.org

Based on observation, staff interview, and review of a facility policy and procedure, it was determined the facility failed to conspicuously post signage, specifying the rights of individuals under EMTALA [Emergency Medical Treatment and Labor Act] Law, with respect to examination and treatment of emergency medical conditions and women in labor.

Findings include:

Reference: Facility policy, "Emergency Medical Treatment and Labor Act (EMTALA) Policy" states, "... Signage: Each Hospital shall post one or more signs conspicuously, in the ED [Emergency Department] (entrance area, waiting areas, and treatment areas), observation unit, or other areas where patients may come seeking emergency treatment... NOTE: Departments other than the traditional Emergency Department where patients may come to the Hospitals must also post appropriate signage. These areas may also include the entrance, admitting areas, waiting rooms, and treatment areas."

1. Upon entering the hospital on 5/9/22, the following was noted:

a. The Main Entrance did not have EMTALA signage.

2. During a tour of the ED [Emergency Department], conducted on 5/9/22, the following areas did not have EMTALA signage:

a. Ambulance Entrance

b. The Alcove labeled, "Restrooms," within the Main ED

c. Pediatric ED - Rooms #P55 through #P66

d. ED POD A - Rooms #A1 through #A21

e. ED POD B - Rooms #B26 through #B40

f. Intermediate Care - Rooms #B41 through #B48

g. ED POD C [ED Observation] - Rooms #C69 through #C78

h. Cardiac Observation Unit - Rooms #2001 through #2016

i. Behavioral Health - Rooms #BH1 and #BH2

j. Behavioral Health Hall Beds - #BH01-03, #BH01-04, #BH01-05, and #BH01-06

3. During a tour of the Labor and Delivery Unit, conducted on 5/10/22, the following areas did not have EMTALA signage:

a. Rooms #5901 through #5918

4. The above findings were confirmed with Staff #3 on 5/11/22 at 3:20 PM.

Based on review of one (1) of one (1) medical record (Medical Record #16) of a patient who was on a one to one observation and eloped from the Emergency Department (ED), staff interview, and review of facility policy and procedure, it was determined the facility failed to ensure all patients on one to one observation are monitored according to facility policy.

Findings include:

Reference: Facility policy "Safety Precautions and Observation Guidelines for Risk of: Elopement of Harm to Self or Other" states, "... Documentation of patient's behaviors will be recorded every 15 minutes by the team member assigned as the patient observer on the HMH Patient Observation Sheet... "

1. Review of Medical Record #16 on 5/11/22, revealed the patient presented to the ED via ambulance on 11/26/21 at 12:56 AM with complaints of alcohol abuse and psychiatric evaluation.

a. Patient #16 had a Medical Screening Exam at 1:36 AM. According to the physician's "History of Present Illness" The patient's Chief Complaint was a Psychiatric Evaluation and the patient was brought to the ED by police after he called the Veterans Hotline multiple times. The patient reported that his PTSD (Post Traumatic Stress Disorder) was getting worse. The patient presented to the ED for evaluation of PTSD and alcohol intoxication.

b. According to the ED notes by the Registered Nurse on 11/26/21 at 2:32 AM, "Patient is becoming more upset and is demanding to get Ativan ... Then he is requesting his nighttime dose of Seroquel."

c. A Blood Alcohol Level was drawn at 1:57 AM. The patient had a blood alcohol level of 266. The reference range for Blood Alcohol is less than 10.

d. In the ED record, in the section titled, "One to One Monitoring," the physician order states, "1:1 Observation ... Authorized by: [name of physician] ... Frequency: STAT Once, continuous, for 24 Hours 11/26/21 0120 - 24 hours ... Reason for Constant Observation ... Elopement."

e. According to the document titled "Patient Observation Documentation Final," a team member documented the patient's behavior every 15 minutes from from 3:00 AM through 4:15 AM. The patient eloped at 4:45 AM. There is no documentation of the patient's behavior at 4:30 AM, 15 minutes prior to the elopement. The patient's behavior was not recorded every 15 minutes according to facility policy.

f. The Registered Nurse (RN) ED note at 4:45 AM states, "Pt. (patient) ran past sitter and ran out the ambulance door while the ambulance crew was arriving. ED Charge Nurse [name of nurse] saw but was too far to catch patient. Call placed to Edison police ..."

2. The above findings were confirmed with Staff #3 on 5/11/22 at 3:20 PM.