HospitalInspections.org

Based on review of policies and procedures, review of emergency medical services (EMS) documentation, and staff interview, the facility failed to develop comprehensive policies related to emergency services. The findings were:

Review of EMS documentation showed on 6/7/17 an out-of-county ambulance crew contacted the emergency department (ED) by telephone. The crew told registered nurse (RN) #1 at the ED they had a 15 year old with a self-induced overdose who was stable enough for transport to their facility. However, prior to hanging up, the ED physician stated the patient needed to go [to a nearby] Clinic or a hospital in another county due to the patient being a pediatric psychiatric patient. The documentation showed the patient was then taken to a nearby clinic and was transported to a children's hospital via air ambulance. During an interview on 7/13/17 at 3:17 PM the ED director stated the EMS crew was told to the take the patient to a closer facility because it was an over-dose, and not because of the psychiatric component. On 7/13/17 at 3:25 PM RN #1 stated the ED physician told the EMS crew that maybe there was a better place to take the patient, and stated the MD never told the EMS crew not to come at all. The following concerns related to policy development were identified:
a. Review of the facility's policies "Scope of Service- Emergency Department" (approved 8/6/14) and "Juvenile Psychiatric Patients in the ED" (approved 9/7/16) showed both policies addressed what to do when a patient arrived at the facility, but did not address communication with EMS who wanted to transport a patient to the ED, including circumstances in which EMS would be told not to bring a patient, and who could make that decision.
b. During an interview on 7/13/17 at 3:17 PM the ED Director stated the facility did not have a written policy to address communication with EMS. She stated what EMS was told depended on the condition of the patient. She stated the ED would take anybody and would never refuse.