HospitalInspections.org

.
Based on record review, interview and video review the facility failed to provide an appropriate medical screening examination (MSE) within the capability of the hospital's emergency department to determine whether or not an emergency medical condition exists for 1 (#21) prospective patient out of 21 emergency room visits reviewed. This failed practice resulted in the patient not receiving a medical screening exam to rule out an emergent medical condition. Findings:

Record review on 9/25-27/18 of the emergency department patient log expanding 6 months prior to survey dates revealed prospective patient #1 was not listed as being triaged, evaluation, admitted or transferred by the facility's emergency department.

During an interview on 9/26/18 at 2:37 pm Witness #1 stated he/she presented to Alaska Regional ED, on 9/11/18 sometime around 5:00 pm with the Prospective Patient (#21), as an escort. He/she noted the ED waiting room wasn't busy. Witness #1 stated he/she approached the triage window and asked the triage LN if his/her client could be seen for a psychiatric evaluation. In response, according to Witness #1, the triage nurse stated "You will have to go somewhere else because the facility didn't have a doctor that did that [psychiatric evaluations]." According to the Witness he/she stated "Alright, thank you." and then exited the ED with the prospective patient. He/she further stated the interaction from the time he/she walked in until the time he walked out was about 1-1.5 minutes. The prospective patient was never screened or evaluated by any medical staff. Once the Witness and Patient #21 left the facility, they went to another local hospital where the prospective patient had a significant loss in mental stability and became very violent.

A camera review was conducted on 9/27/18 at 1:10 pm with Security Officer and Compliance/Quality Officer staff present. Review of ED entrance/waiting area video (entering from hospital entrance through ED waiting area toward triage window) on 9/11/18 at 4:54 pm revealed Witness #1 and Prospective Patient #1 entered to the ED waiting room approached the triage window area. After a brief moment at the triage window area the two individuals left. The total time between entering the ED area and exiting the area was 1 minute. The triage window was unable to be viewed by any camera view.

Review of the ED staff assignment sheet, dated 9/11/18, revealed Licensed Nurse (LN) #2 was listed as being the triage nurse for that day, during the day shift.

During an interview on 9/27/18 at 1:10 pm, LN #2 was asked if he/she was working on 9/11/18 at approximately 4:30 pm to 5:30 pm. LN #2 stated he/she didn't recall but if the ED staff assignment sheet stated he/she was assigned to triage, then he/she worked triage that day. When asked what the process was when a patient was checked into ED with psychiatric concern, LN #2 stated they would set the patient up with tele-psych, conduct an evaluation, and may need to make a referral to other resources.

During the same interview, LN #2 stated ED did not log in anyone until they got a name, come into triage area or wrote on the standardized ED form and brought it back to the triage LN. When shown a picture of the prospective patient, the LN stated he/she did not remember seeing him/her that day or speaking to anyone about a psychiatric evaluation. LN #2 further stated if someone wanted to be evaluated for psychiatric concerns they should have been checked in and evaluated.

Review of the facility's policy entitled "EMTALA Medical Screening Exam," review date of May 2018, revealed "An EMTALA obligation is triggered when an individual comes to a dedicated emergency department ('DED') and ...the individual or representative acting on the individual's behalf request an examination or treatment for a medical condition ...A hospital must provide an appropriate MSE within the capability of the hospital's emergency department ...to determine whether or not an [emergency medical condition: EMC] exists ...an individual who has such a request made on his or her behalf ...an individual whom a prudent layperson observer would conclude from the individual's appearance or behavior needs an MSE. An MSE shall be provided to determine whether or not the individual is experience an EMC ..."

Review of the facility's policy entitled "Triage Area Responsibilities," dated March 2016, revealed " ...All patients will receive a medical screening exam by a physician ...Upon arrival to the Emergency Department, patients are assessed for priority of care. The first point of contact upon entrance to the Emergency Department is a triage nurse."