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Based on medical record review, interviews with staff, a review of the facility surveillance video, and a review of the facility's policies, it was determined the facility (facility A-Northside Hospital of Atlanta) failed to Provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists for (P#1) of 20 sampled patients who presented to the hospital's emergency department on 4/7/22 and was directed to another facility (facility B) by a staff member.

Findings were:

Cross refer A-2406, as it relates to the facility's failure to provide P#1 with an appropriate medical screening examination.

Based on a review of the facility's central log, interviews with staff, review of the facility surveillance video, and a review of the facility's policies, it was determined the facility failed to maintain a central log of all patients who present to the ED when one patient (P #1) out of 20 sampled presented to the ED, but was not recorded into the central log on 4/7/22.

Findings:


A review of the ED video footage dated 4/7/22 showed a female walking in the ED main lobby holding a car seat at 11:26:41 p.m. she was escorted in the lobby by an ED personnel (identified as Tech BB). They both stopped at the registration window and spoke with another ED personnel (identified as Tech AA). The staff who escorted the female person walked back outside. At 11:27:15 video footage showed the female person (identified as P#1 ' s parent) leaving the lobby. P#1 ' s mother entered the lobby at 11:26:41 p.m. and walked out at 11:27:15 p.m.


A review of the facility's central log was conducted. The facility's central log failed to reveal that on 4/7/2022 that P#1 presented to the ED. The facility failed to ensure that their facility Policy was followed as evidenced by failing to maintain a daily log for Patient #1 on 4/7/2022, when the patient presented (in mother's arms) to the hospital ED and mother requesting medical assistance.

The facility's Policy titled "Access to Emergency Medical Condition, Document ID:11355; Revision Number: 9: Revision Official date 1/29/2020 was reviewed. The Policy revealed in part, "E. Record Keeping: 1. Daily Logs: The Emergency Department and Labor and Delivery will each maintain daily Logs of all persons presenting for medial examination or treatment, which will include disposition."

A Review of policy title "Assessment and Documentation of the Emergency Department Patient" revealed in part, "Upon arrival to the ED the patient was registered by emergency room staff who completed a quick registration and placed an armband on the patient." The facility failed to ensure that their policy was followed as evidenced by failing to register and failed conduct a quick registration as stated in their policy for Patient #1 on 4/7/2022.


During a phone interview with Tech (AA) on 4/26/22 at 10:10a.m., Tech AA stated she remembered P#1 ' s mother came with P#1 and asked her "Are you guys busy?", Tech AA said her answer was yes. Tech AA asked the P#1 ' s mother if she came for her or for the baby. She replied that she was for the baby (P#1). Tech AA said she was trying to help her get help fast for the baby and told her that there was a baby hospital across the street as an option but told her that they were happy to assist her if she wanted to stay. Tech AA said she was assigned to do registration in the ED the night the mother came with the baby. Tech AA said that she received EMTALA training annually and as needed, and she knew that by law the facility can never deny somebody medical service once they get to the ED or in the hospital grounds.

During an interview on 4/26/22 at 10:15a.m. in the conference room with the Manager of Quality and Patient Safety (GG) in the conference room, Manager GG said she believed Tech AA gave the mother the information about the other facility to help but unfortunately it violated EMTALA law. Manager GG said as soon as they knew about the incident, they jumped on it by reeducating their staff.

Based on medical record review, interviews with staff, a review of the facility surveillance video, and a review of the facility ' s policies, it was determined the facility (facility A-Northside Hospital of Atlanta)failed to Provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists for (P#1) of 20 sampled patients who presented to the hospital's emergency department on 4/7/22 and was directed to another facility (facility B) by a staff member.


The findings were:


A review of the ED video footage dated 4/7/22 showed a female walking in the ED main lobby holding a car seat at 11:26:41 p.m. she was escorted in the lobby by an ED personnel (identified as Tech BB). They both stopped at the registration window and spoke with another ED personnel (identified as Tech AA). The staff who escorted the female person walked back outside. At 11:27:15 video footage showed the female person (identified as P#1 ' s parent) leaving the lobby. P#1 ' s mother entered the lobby at 11:26:41 p.m. and walked out at 11:27:15 p.m.

A Review of policy F-013, last revised 1/29/20 title "Access To Emergency Medical Treatment" revealed in part, "A Provision of Medical screening Examination: A Scope of Medical Screening Examination. All patients who presented to the Emergency Department ...and requested examination or treatment for a medical condition were to receive an appropriate medical screening examination ...Pediatrics patients will receive a medical screening examination and stabilizing treatment. If requires stabilizing treatment is outside of the scope of services available as Northside, the pediatric patient will be subject to a medically appropriate transfer ... The screening examination was to include any appropriate ancillary services as were generally available to patients in the Emergency or Labor and Delivery Departments ...Responsibilities of other Department and areas ..."No Hospital employee will direct any person on Northside Hospital property to obtain emergency services from another medical facility. "

A Review of policy title "Assessment and Documentation of the Emergency Department Patient" revealed it was the policy of the facility to assess all patients. The assessment began with triage and progressed through the initial assessment, ongoing reassessment and through the patient's final disposition. This assessment may be either a brief focused assessment or a comprehensive evaluation of all systems as related to the presenting complaint. All patients who presented to the Emergency Department received an appropriate medical screening by an Emergency Department physician, or an Advanced Practice Provider (APP) in consultation with the Emergency Department physician to determine if an emergency medical condition existed. Triage/Initial Assessment: ...The RN performed an initial assessment and assigned an ESI Triage Acuity level and placement of the patient. After assignment of ESI level the patient was placed in a treatment area. The RN performed the Primary Assessment of Airway, Breathing, Circulation, and Level of Consciousness.

The Medical Record (MR) for Patient #1 from Facility B was reviewed.
Review of the MR dated 4/8/2022 at 12:04. a.m., revealed the patient was called to triage and appeared to be extremely pale and lethargic. The chief complaint was listed as altered mental status. The section of the Medical Record titled "History and Physical" revealed in part, "Patient #1 5w (week) ...who presents with lethargy today. Patient has not fed in over 12 hrs. (hours). Mother initially went to Northside Hospital ...and she was referred here for evaluation. At triage the patient was very pale and listless the patient was immediately brought back to the resuscitation bay. The patient was found to be hypothermic (dangerous drop in body temperature) 33.2 degrees (normal temperature -pediatric 37.0 degrees) ...while patient was being stabilized, the patient had a seizure. Patient with significant desat (desaturation-drop in blood oxygen level) and bradycardia (drop in heart rate). This lasted for about a minute ...RAM (intended to be used for patients who require supplemental oxygen, respiratory support or assistance with breathing) cannula support. The patient did not have respirations and had subsequent hypoxia (state in which oxygen is not available in sufficient amounts at the tissue level to maintain adequate homeostasis(https://www.ncbi.nlm.nih.gov). ...Medical Decision Making: Airway/Breathing. Patient with acute respiratory failure ...Had chest rising with bagging ...Patient placed on mechanical ventilation protocol." Patient #1 was admitted to the PICU (Pediatric Intensive Care Unit).


During a phone interview with Tech (AA) on 4/26/22 at 10:1., Tech AA stated she remembered P#1 ' s mother came with P#1 and asked her "Are you guys busy?", Tech AA said her answer was yes. Tech AA asked the P#1 ' s mother if she came for her or for the baby. She replied that she was for the baby (P#1). Tech AA said she was trying to help her get help fast for the baby and told her that there was a baby hospital across the street as an option but told her that they were happy to assist her if she wanted to stay. Tech AA said she was assigned to do registration in the ED the night the mother came with the baby. Tech AA said that she received EMTALA training annually and as needed, and she knew that by law the facility can never deny somebody medical service once they get to the ED or in the hospital grounds.

During an interview on 4/26/22 at 10:15 a.m. in the conference room with the Manager of Quality and Patient Safety (GG) in the conference room, Manager GG stated they did annual training with all their staff and do more EMTALA training with ED staff just to make sure staff understood the EMTALA law. Manager GG said during training they went to specific details about EMTALA education for staff working in ED and Labor and Delivery ED just to prevent mistakes like this from happening. Manager GG said she believed Tech AA gave the mother the information about the other facility to help but unfortunately it violated EMTALA law. Manager GG said as soon as they knew about the incident, they jumped on it by reeducating their staff about EMTALA law. Manager GG said in their current corrective action they created an attestation form as a supplement to make sure staff understood how serious EMTALA was. Manager GG also said they started a Root Cause Analysis that was in progress as of now.

During an interview with Tech (BB) on 4/26/22 at 11:48 a.m. in the conference room, Tech BB said she was working the tent the night the mother came in with the baby. Tech BB said she remembered the mother because she was doing the COVID screening at the ED entrance. Tech BB said after the COVID screening she escorted the mother to the registration window and told Tech AA who was doing registration that night that the mother said the baby was not well and she came for the baby to see a doctor. The mother said she brought the baby here because the baby was born at the facility. Tech BB said she went back to the tent to do her job because that's where she was assigned. Tech BB said shortly after she saw the mother walking out and she didn't question her.


In an interview with the ED Director (HH) on 4/26/22 at 2:45 p.m. in the conference room, Director HH said he learned about the incident on the following Monday. Director HH said they started supplemental EMTALA education with their staff that same Monday and it was a face-to-face education training not computer based because they wanted to make sure that the staff got it. Director HH said they added an attestation form which they did not require before during their annual EMTALA training. He also stated they have started a Root Cause Analysis to get to the cause and learn how to prevent that from happening in the future. Director HH said they had 45 days to finish the investigation. Director HH confirmed that the ED was not on Diversion that day.

The facility failed to ensure that their policies and procedures were followed as evidenced by failing to ensure that staff did not direct any patients (patient #1) on hospital property (Northside Hospital) to another hospital. Additionally, the facility failed to ensure that upon arrival on 4/7/2022 patient #1 was not triaged and did not receive a medical screening examination as stated in the facility's policy. Upon arrival to Hospital B; the patient was taken immediately back had a seizure with altered mental status and hypothermia and was admitted to facility B's ICU in critical condition.