HospitalInspections.org

Based on observation and staff interview, the hospital failed to post a sign visible in the ED waiting room describing patient rights for emergency examination and treatment of medical conditions. Findings include:

Based on observations during the initial tour of the Emergency Department (ED) on 1/31/12 commencing at 12:35 PM, the patient waiting room did not have the required EMTALA signage describing patient's rights under EMTALA rules. This was confirmed during interview with the Medical Director of the Emergency Department at 12:50 PM. The physician confirmed the only posted EMTALA sign was in the entry to the ED department.

Based on staff interview and record review, the hospital failed to assure that 1 applicable patient's emergency medical condition was stabilized prior to discharge from the Emergency Department (ED). The patient was 1 of 23 targeted patients presenting to the Emergency Department during the sampled period. (Patient #1) Findings include:

Per record review on 1/31/12, Patient #1 was seen in the ED on 1/19/12 at 1218 for ingestion of opiods and suspected overdose and was discharged back to the referring facility prior to medical stabilization. Per review of the Physician Assistant's (PA) ED Record, the patient admitted to taking 40 mg of methadone at approximately 9:30 AM. Although the patient was treated with Narcan and charcoal between 1240 and 1255, and was noted to be improved at 1315, the RN wrote that at 1400 VS (vital signs) included B/P 158/107, P 97 RR (respiratory rate) was 8. VS at 1425 were 136/96, 99 and RR (respiratory rate) was 16. The patient had pulled out the IV at 1315 (no reason given).

Per review of the Physician Emergency Record, the patient's O2 saturations and RR were WNL (within normal limits) and the PA called the referring facility to say that the patient was ready for discharge (no time documented). The RN Emergency Record noted discharge at 1450 hours, less than 1 hour after abnormal VS were documented. The ED staff failed to follow internal policies for ED discharges regarding stable patient VS X 6 prior to discharge. Per telephone interview on 2/1/12 at 11:20 AM, the RN could not remember any communication of the slow RR to the PA, . During interview on 1/31/12 at 4:05 PM, the PA said she was not informed by the RN of the patient's slow respiratory rate at 1400.

The patient returned to the ED at 1750 after again becoming symptomatic of an overdose, (experiencing an O 2 Sat of 88%, below normal). The patient was subsequently admitted to the hospital for further treatment and monitoring of the opiod overdose.