HospitalInspections.org

Based on document review and interview the facility failed to provide appropriate education for the Labor and Delivery nurses to perform a medical screening exam (MSE), potentially resulting in a failure to identify an emergency medical condition (EMC) for all patients being treated at the facility. Findings include:

On 8/12/13 at approximately 1400 during review of the policy titled Patient Transfer to Another Facility (EMTALA/COBRA) Review Date 3/09 it was stated under Definitions number 5. "Qualified Medical Personnel: An individual qualified by the Board to conduct screening examinations, and stabilizing treatment, as documented in the bylaws or rules and regulations. For the purposes of this policy the physician assistants employed by Battle Creek Emergency Physicians are qualified medical staff. Additionally, the OB nurses employed by BCHS are qualified medical personnel in the case of a woman having contractions."

On 8/12/13 at approximately 1145 during an interview with L&D nurse, staff I the following was stated "The physicians are not here at night, so we assess the patient when they come in and then call the physician on call. They then give us orders for the patient." This surveyor then asked "Are the nurses on this floor qualified to do a medical screening exam?" Staff I stated "No, the physicians do that." This surveyor asked "Are the nurses given any education on how to do a medical screening exam?" Staff I stated "No". This surveyor asked "How does the physician do a medical screening exam at night, if they are not here?" Staff I stated "The nurses call and talk to them on the phone and tell them about the nursing assessment, then they take that information to decide what to do."

On 8/12/13 at approximately 1200 during an interview with nurse mid-wife, staff J the following was stated "At night I do a medical screening exam and then call the physician on call, they then make all the decisions about care." This surveyor asked "Have the nurse mid-wives been given education on how to do a medical screening exam and identify an emergency medical condition?" Staff J stated "No, however, the doctors are the ones who make all the decisions and decide if there is an emergency medical condition and what to do." This surveyor asked "Do all patients see a physician if they come in at night and leave before day shift?" Staff J said "No, but every patient that leaves before a doctor arrives is assessed and then we talk to the doctor about orders and discharge."

On 8/13/13 at approximately 1215 this surveyor reviewed the hospital wide EMTALA online training, which did not discuss how to perform a MSE to identify an EMC.

ON 8/13/13 at approximately 1215 during an interview with staff G, it was stated "No, there is not any education given on EMTALA or MSE's other than this EMTALA online training."

On 8/13/13 at approximately 1230 during an interview with staff G, the manager of the L&D department, it was confirmed that no education regarding a medical screening exam and how to identify an emergency medical condition is given to the nurses or nurse mid-wives at this time.

Based on document review and interview, it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to ensure an adequate medical screening exam was performed by a qualified medical professional as appointed in the Bylaws. See A 2406.

Based on document review and interview, it was determined that the facility failed to ensure an adequate medical screening exam (MSE) was performed on 2 out of 14 patients (#10, #15) by a qualified medical professional as specified in the Bylaws of the Medical Staff of Bronson Battle Creek resulting in unappointed and unqualified medical professionals performing medical screening exams on patients that enter the emergency room and the labor and delivery unit. Findings include:

On 8/12/13 at approximately 1430 during review of the Bylaws for the Medical Staff it was revealed that the qualified medical professionals approved to do MSE ' s were not designated in the bylaws.

On 8/12/13 at approximately 1430 during an interview with staff B it was stated "We have not identified in the Bylaws, who is appointed to do a MSE."

On 8/12/13 at approximately 1400 during review of the policy titled Patient Transfer to Another Facility (EMTALA/COBRA) Review Date 3/09 it was stated under Definitions number 5. "Qualified Medical Personnel: An individual qualified by the Board to conduct screening examinations, and stabilizing treatment, as documented in the bylaws or rules and regulations. For the purposes of this policy the physician assistants employed by Battle Creek Emergency Physicians are qualified medical staff. Additionally, the OB nurses employed by BCHS are qualified medical personnel in the case of a woman having contractions."

On 8/12/13 at approximately 1500 during review of the medical records #10 and #15 for the ED it was revealed that 2 out of 14 patients had MSE's conducted by a nurse practitioner.

On 8/12/13 at approximately 1500 during an interview with staff B it was confirmed that nurse practitioners are not designated in the policy or bylaws to perform a MSE.