HospitalInspections.org

This standard is not met based on staff interview, medical record review, and facility policy and procedure review, the hospital failed to provide appropriate medical screening exam for two (2) out of 20 patient charts reviewed: Patients #1, #15.

Findings Include:

Cross Refer to findings at A-2406 for the facility's failure to provide appropriate medical screening exam.

Based on staff interview, medical record review, emergency room committee meeting minutes, and facility policy and procedure review, the hospital failed to provide a thorough medical screening examination for two (2) out of 20 patient charts reviewed: Patients #1, #15.

Findings Include:

Patient #1

A review of the medical record revealed Patient #1 presented to the Emergency Department (ED) at 11:31 p.m. on 11/02/2022 with complaints of heart racing. Medical record review revealed triage was completed at 11:45 p.m. with an acuity level of 3. Medical record review of the triage note revealed the patient was placed back in the lobby to wait on an available room. Medical record review of ED triage note revealed that Patient #1's heart rate ranged from 38 to 137 beats per minute in triage. Medical Record review revealed Patient #1 had an Electrocardiogram (EKG) at 11:38 p.m. Medical record review of EKG results revealed the patient was in atrial fibrillation with rapid ventricular response which was confirmed by the Physician at 8:52 a.m. on 11/03/2022, which was nine (9) hours after the EKG was completed and the patient had left without being seen. Medical record review of discharge documents revealed the patient left the ED on 11/03/2022 at 1:04 a.m. without being seen by a provider.

Review of the policy and procedure "Evaluation and Transfer of Patients with Emergency Medical Conditions" (dated 1/92, revised 12/21) revealed that " ...Persons requesting examination or treatment for medical conditions are provided an appropriate medical screening examination to determine whether or not they have emergency medical conditions ...".

Review of the facility's policies and procedures for "ED: Triage" (effective date 12/98, revised 6/21) revealed, " ...Triage (ESI) Levels: 1-Critical: Requires immediate resuscitation or lifesaving intervention, 2-Emergent: Unstable vital signs, high risk situation, confused/lethargic/disoriented, severe pain/distress. 3-Urgent: Serious condition but not life threatening required multiple resources. 4-Non-Urgent: Requires minimal diagnostic resources for treatment. 5-Minor: Requires no diagnostic resources for treatment ...".

Review of the facilities Emergency Committee Meeting minutes revealed the facility reviews "Left Without Being Seen" (LWBS) percentages and ED hold minutes every other month. Review of the meeting minutes for January 12, 2022, revealed that the facility had an increase of LWBS from December 2021 of 5.87% to 8.6% and an increase in ED Hold hours from 6029.4 to 6859. Review of the most recent meeting minutes on 11/09/2022 revealed that the facility LWBS had increased to 13.09 % in the month of October and the ED Hold hours had increased to 10686.4.

Patient #15

A review of the medical record timeline for Patient #15 revealed the patient arrived at Emergency Department at 10:56 p.m. on 11/03/2022 with complaints of chest pain and weakness. Medical record review revealed the patient was triage at 11:03 p.m. with an Acuity level 4. Medical record review revealed the patient left without being seen at 2:37 a.m. on 11/04/2022. Medical record review revealed the patient waited three (3) hours and 41 minutes prior to leaving without being seen and did not have and EKG performed, per guidelines.

Review of the facility's "Unit Specific Guidelines" (not dated) revealed " ...Patients presenting with chest pain ...Door to EKG in less than 10 minutes if: Chest pain less than 24 hours. Patient age greater than 30 ...".

During an interview with the Associate Administrator of the Emergency Department (AAOED) on 12/14/2022 at 10:35 a.m., it was revealed the Emergency Department (ED) was on diversion related to capacity issues on 11/02/2022. AAOD reported that the ED has 43 beds and that 41 were being used as bed holds for the floor related to staffing issues on the floor.

During an interview with the Emergency Department Nurse Manager (EDNM) on 12/14/2022 at 3:30 p.m., it was revealed it is normal for a patient to have to wait four to six hours for a Medical Screening Exam because the ED does not have enough available beds due to using the ED for bed holds for the other units. EDNM reported they have a Physician and a Nurse Practitioner 24 hours a day to do the Medical Screening Exam (MSE) but the ED does not have any physical beds to room the patients due to all the beds are taken with bed holds for the floor and Intensive Care Unit (ICU). The EDNM reported they have had 13 resignations in the ED in the past 2 weeks.

During an interview with the AAOD on 12/14/2022 at 4:05 p.m. it was revealed that the only reason the ED is not able to see all of the patients in a timely manner is because of not having enough beds available due to bed holds for the rest of the hospital. AAOD reported that the backup is related to a staffing issue on the other units.

During an interview with the Director of Accreditation (DOA) on 12/14/2022 at 4:20 p.m. it was revealed the facility has a staffing issue on the floor and in Intensive Care Unit (ICU). DOA reported the facility had to shut down units in the hospital related to not having enough staff. DOA reported they have to leave the patients in the ED so that they will have staff to care for them.

During exit conference on 12/17/2022 at 4:00 p.m. with the Director of Accreditation and the Director of Risk Management survey findings were discussed and no further documentation was submitted for review.