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 ensure that all patients who presented to the Emergency Department (ED) were included in the hospital's ED log.

Cross Reference: C 2405

2. The hospital failed to provide a medical screening examination for 2 patients who were triaged, and left without beings seen and the complaint index patient who was not registered.

Cross Reference: C 2406

3. The hospital failed to ensure that patients who decided to leave the hospital's ED against medical advice (AMA) would have documented that on the hospital's "Leaving Hospital Against Medical Advice" form for 3 of 6 patients who left against medical advice.

Cross Reference: C2407

4. The hospital failed to ensure that patients being transferred to other facilities had documentation on the hospital's "Interfacility Transfer Form" for 1 of 4 patients transferred to another facility.

Cross Reference: C 2409
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Based on interview, document review, and review of hospital policies and procedures, the hospital failed to ensure that all patients who presented to the hospital for emergency or obstetric care were entered into the Emergency Department log.

Failure to include all patients presenting to the hospital for emergent or obstetric care puts patients at risk for not receiving a medical screening examination (MSE), stabilizing treatment, and appropriate discharge or transfer, leading to patient harm or death.

Findings included:

1. Review of the hospital's policy titled, "Emergency Medical Treatment and Labor Act (EMTALA), number 9346, approved 03/30/23, showed that all hospital departments where a patient might present for emergency services or receive a Medical Screening Examination, including the Emergency Department (ED), would maintain EMTALA Central Logs, which would identify the patients who have presented for such services, along with a description of the outcome of their presentation.

2. Review of the hospital's ED log showed that the complaint index patient, who presented to the Emergency Department on 05/08/23 at approximately 5:30 PM, was not entered into the hospital's ED log (EMTALA Central Log).

3. On 06/01/23 at 5:08 PM, during an interview with the investigator, an admitting representative, (Staff #6), stated that the patient and her husband came into the ED registration area asking for the obstetrics department (OB). Staff #6 told them that the OB department had closed, but they could be seen in the ED. The patient's husband asked where the nearest OB department was, and Staff #6 told him either Yakima or Sunnyside. Staff #6 asked for the patient's information. The patient refused to give her name or date of birth.

4. On 05/30/23 at 10:50 AM, during an interview with the investigator, the System Director for Quality and Risk/Interim Chief Nursing Officer, (Staff#1) stated that the index patient was not registered into the ED log.
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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 3 of 25 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. 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 two patients presented to the Emergency Department (ED) and were registered into the ED log, and received triage by the registered nurse. When called to be seen by the provider, the patients were not present in the ED lobby and were documented as having left without being seen (LWBS) (Patient #2, Patient #14). The complaint index patient presented to the ED on 05/08/23 at approximately 5:30 PM, but was not registered, triaged, or seen by the ED provider. No information was obtained to identify the patient, except that she was pregnant and wanted to be seen in the OB department.

3. On 05/30/23 at 1:30 PM, during an interview with the investigator, the Quality Manager (Staff #2) verified that there had been no medical screening examinations performed for the 2 patients that left without being seen, or for the complaint index patient.
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Based on interview, document review and review of hospital policies and procedures, the hospital failed to obtain, or attempt to obtain, a written refusal of care for 3 of 6 patients leaving against medical advice (AMA) (Patient #16, Patient #20, Patient #23).

Failure to obtain a written refusal risks patients' lack of understanding of the risks and benefits of remaining at the facility until an appropriate transfer for care could be facilitated resulting in possible patient injury or death.

Findings included:

1. Review of the hospital's policy titled, "Against Medical Advice (AMA)(Leaving Medical Facility), number 8924, reviewed 06/17/22, showed that if the patient insisted on leaving AMA, the "Leaving Hospital Against Medical Advice" form must be completed in duplicate, explained to and signed by the patient or legal representative. The patient's signature needs to be witnessed.

2. Medical record review showed that the reasons patients that left AMA but did not sign a "Leaving Hospital Against Medical Advice" form inlcuded one who did not want to wait for additional test results, one refused admission to the hospital and one who did not want to wait for an appropriate transfer to another faclility.

3. On 05/30/23 at 1:37 PM, during an interview with the investigator, the Quality Manager, (Staff #2), stated that there were no "Leaving Hospital Against Medical Advice" forms present in the charts of Patient #16, Patient #20, or Patient #23.
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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 were in compliance with CMS EMTALA regulations for 1 of 4 patients transferred to other facilities (Patient # 8).

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 4 patients transferred to another facility did not include an Interfacility Transfer Form, as required by hospital policy (Patient #8).

3. On 05/30/23 at 1:15 PM, during an interview with the investigator, the Quality Manager, (Staff #2) stated that there was no Interfacility Transfer Form in the medical record of Patient #8.
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