HospitalInspections.org

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Based on observation, interview, record review and review of hospital policies and procedures, the hospital failed to develop and implement policies and procedures for evaluation and treatment of patients presenting for emergency
care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health care outcomes, injury, and
death.

Findings included:

1. The hospital failed to provide a medical screening examination for 1 patient who was triaged and left without being seen by the Emergency Department Provider before going to another hospital.

Cross Reference: A 2406

2. The hospital failed to ensure that patients being transferred to other facilities had documentation on the hospital's "Interfacility Transfer Form" for 1 of 7 patients transferred to another facility.

Cross Reference: A 2409
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Based on interview, document review, and review of hospital policies and procedures, the hospital failed to provide medical screening examinations for 1 of 7 obstetric patient medical records reviewed.

Failure to provide medical screening examinations for patients presenting to the Emergency Department for care risks patients not receiving care resulting in illness, injury, or death.

Findings included:

1. Document review of the hospital's policy titled, "Emergency Medical Treatment and Labor Act (EMTALA)," number 9346, reviewed 01/12/23, showed that a medical screening examination (MSE) was required to reach the point at which it could be determined whether an emergency medical condition existed. The MSE was a continuous process reflecting appropriate monitoring in accordance with a patient's needs. Triage by a nurse is not an MSE. The purpose of triage was to ascertain the nature and severity of a patient's complaint to determine the order in which patients are seen by a provider.

2. Medical record review showed that one patient presented to the Emergency Department (ED) on 07/27/23 and was registered into the ED log and was triaged by the registered nurse. A pelvic ultrasound was ordered (Patient #22).

3. On 08/29/23 at 9:27 AM, during an interview with the investigator, an ultrasound technician (Staff #1) stated that they received an order for a pelvic ultrasound [for Patient #22] and went to get the patient from the Emergency Department waiting room. They took the patient to radiology and began the ultrasound. When they applied the transducer to the patient's abdomen, they saw a fetus and immediately stopped the procedure. Staff #1 told the patient that they were not certified to do an obstetric ultrasound and returned the patient to the waiting room. Staff # 1stated that they told the patient that they would have to find out what the doctor planned to do.

4. On 08/29/23 at 9:17 AM, during an interview with the investigator, a Patient Access Representative (Staff #4) stated that the patient returned from radiology and came up to their desk. The patient said that the nurse told her that the test had to be done in Sunnyside. Staff #4 stated that they told the patient that when they came back from Sunnyside, they were to come back to her desk and she would check them back into the Emergency Department.

5. Medical record review showed a nursing note dated 07/27/23 at 12:48 PM, that the patient was at the front desk and asked if she should go to Sunnyside for her ultrasound. The admitting clerk [Patient Access Representative] called the ED nurses desk and was told that the patient would have to go to Sunnyside for her ultrasound. The patient left the hospital and drove to Sunyside. There was no physician discharge or transfer order in the medical record (Patient #22).

6. Document review of an email memo dated 07/27/23 at 6:27 PM, from the Patient Access Manager (Staff # 2) to the patient access staff members showed that the subject was EMTALA and the importance was HIGH. The memo showed that there had been an EMTALA violation that day when a patient was triaged but sent to Sunnyside hospital prior to the patient having a medical screening examination.

7. On 08/29/23 at 4:50 PM, during an interview with the investigator, the System Director of Quality (Staff # 3) stated that the patient did not receive a medical screening examination by a qualified provider.
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Based on interview, document review, and review of hospital policies and procedures, the hospital failed to ensure that documentation of patient transfers was in compliance with CMS EMTALA regulations for 1 of 7 patients transferred to other facilities (Patient # 22).

Failure to provide complete documentation of patient consent, physician certification, receiving hospital acceptance, and physician to physician and nurse to nurse communication risks inappropriate transfer and poor patient outcomes.

Findings included:

1. Review of the hospital policy titled, "Emergency Medical Treatment and Labor Act (EMTALA)," number 9346, approved 03/30/23, showed that when a patient is transferred, the consent of the receiving hospital to accept the
transfer must first be obtained and documented on the Interfacility Transfer Form, as well as in the medical record.

2. Medical record review showed that 1 of 7 patients transferred to another facility did not include an Interfacility Transfer Form, as required by hospital policy (Patient #22).

3. On 08/29/23 at 4:50 PM, during an interview with the investigator, the System Quality Director, (Staff # 3) stated that there was no Interfacility Transfer Form in the medical record of Patient #22.
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