HospitalInspections.org

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Based on observations in the Emergency Department (ED) the facility failed to post signs in all ED entrance areas specifying the rights of individuals to examination and treatment of emergency conditions and whether the hospital participates in the Medicaid program.

Findings:

A tour of the Emergency Department on 05/16/11 at 11:00AM revealed no signage was posted in the adult waiting room near the area of the second walk in entrance and the ambulance entrance.

Interviews with Administration during the on site survey confirmed these entrances have twenty-four (24) hour access by patients and their families.
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1) Based on document review and interviews, the facility failed to ensure that pregnant patients, greater than sixteen (16) weeks gestation, who presented to the Emergency Department (ED) were entered into the central log, before being escorted to Labor and Delivery (L & D).

Findings:

Review of the ED Central Log revealed no evidence that pregnant patients who presented to the ED with non-medical complaints were entered in the ED Central Log.

Interviews with Staff #1, Staff #2 and Staff #4 in the morning of 05/17/11 revealed that pregnant patients who were sixteen - twenty-four (16-24) weeks gestation presenting to the ED with obstetrical complaints were transferred to Labor and Delivery without being entered into the Central ED Log.

The facility's policy entitled "Triage of Pregnant Patients Who Present to the Emergency Department", dated 01/01/10, reveals that the ED nurse, after obtaining the chief complaint and patient's gestational age should call the L & D triage staff before sending the patient. The L & D staff must generate a "Triage Call Form".

There is no documented evidence that the ED staff communicated to the L & D Department when a patient was being escorted to the unit.

Interview with Staff #6 and Staff #7 in the L & D unit on the afternoon of 05/17/11 revealed that they consider their triage log the "Triage Call Form". However, the staff does not always document whether the patient was transferred from the ED in the comments section of the form.

Review of the current "Attending Administrative Manual" revealed that the ED staff will contact the L & D unit and inform them of the patient's name, private attending, length of gestation and presenting complaint prior to escorting the patient to L & D.




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2.) Based on interviews and review of the Emergency Department Central Log, the facility failed to maintain a comprehensive log that is accurate, complete and easily retrievable.

Findings:

The Central Emergency Department Log was requested on the morning of 05/16/11 but could not be provided. A second request was made at 1:30PM on 05/16/11 for printouts of five (5) randoms dates: 02/10/11, 03/10/11, 04/06/11, 05/06/11 and 05/07/11, which was not available until 05/17/11, the next day.

An interview with Staff #13 on 05/17/11 at 10:20AM revealed that the facility does maintain an Emergency Department Log however, it cannot be viewed on request.

On 05/17/11 at 10:30AM, a request was made for the ED Central Log dated 05/15/11 which was provided at 2:30PM, four (4) hours after it was requested.

Review of the ED Log revealed no entries for the disposition status of patients in five (5) out of six (6) requested dates. The log lacked the date, time and disposition of multiple patients on 02/10/11, 03/10/11, 04/06/11, 05/06/11 and 05/07/11.

This finding was confirmed on interview with Staff #13 on 05/18/11 at 11:30AM.
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Based on record review and interviews there was no documented evidence of ongoing monitoring after triage to determine if an Emergency Medical Condition (EMC) existed for four (4) out of nine (9) patients who presented to the Emergency Department (ED) and Left Without Being Seen (LWBS) (Patients #16, #25, #26 and #28).


Findings:


Review of the ED record for Patient #28 revealed the patient was triaged on 04/06/11 at 11:49PM with complaints of syncope and left at 4:29AM before the Medical Screening Examination (MSE) was conducted. The patient's disposition was LWBS. There was no documented evidence of a nursing reassessment within two (2) hours as required by the Emergency Department Nursing Education Manual.

Review of the ED record for Patient #25 revealed the patient was triaged on 05/15/11 at 3:08PM with complaints of abdominal pain and left at 5:51PM before the MSE was conducted. The patient's disposition was LWBS. There was no documented evidence of a nursing reassessment within two (2) hours as required by the Emergency Department Nursing Education Manual.

Review of the ED record for Patient #16 revealed the patient was triaged on 05/07/11 at 12:56AM with complaints of right flank pain and left at 3:22AM before the MSE was conducted. The patient's disposition was LWBS. There was no documented evidence of a nursing reassessment in two (2) hours as required by the Emergency Department Nursing Education Manual.

Review of the ED record for Patient #26 revealed the patient was registered on 05/15/11 at 5:36PM for complaints of eye allergies and left at 8:34PM before the MSE was conducted. The patient's disposition was LWBS. There was no documented evidence of nursing reassessment within two (2) hours as required by the Emergency Department Nursing Education Manual.

Review of the facility's policy entitled "Triage for Patients in the Emergency Department" dated June 2007, revealed that an ED Registered Nurse needs to reassess the patients waiting to be seen in the waiting room for any change in condition. The reassessment must be documented and timed by the nurse in the patient's medical record.

Review of the current Emergency Department Nursing Education Manual documented that "All patients waiting in the waiting room or in an area longer than 2 hours will be reassessed."

Interview with Staff #3 on 05/17/11 revealed that all patients waiting in the waiting room are reassessed by the triage nurse two (2) hours after the initial assessment for any changes in acuity.
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Based on record review the facility did not consistently document the refusal of examination or treatment and inform the patient of the risks and benefits of leaving Against Medical Advice (AMA) in one (1) out of five (5) medical records reviewed (Patient #37).

Findings:

Review of medical record for Patient #37 revealed the patient presented to the Emergency Department (ED) on 04/06/11 at 6:08PM with complaints of nausea and vomiting. The patient was triaged at 6:09PM and seen by the ED physician at 7:25PM. The physician noted at 9:54PM that the patient had left against medical advice.

There was no documented evidence in the medical record that the patient signed the "Release When Patient Leaves Hospital Against Medical Advice (AMA)" form.

The "Physician's Certification" section of the AMA form documenting when a patient leaves the hospital against medical advice indicating the physician explained the risks and benefits was not completed or signed by the physician.

This finding was confirmed by hospital Administration on 05/18/11.

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1) Based on document review and interviews, the facility failed to ensure that pregnant patients, greater than sixteen (16) weeks gestation, who presented to the Emergency Department (ED) were entered into the central log, before being escorted to Labor and Delivery (L & D).

Findings:

Review of the ED Central Log revealed no evidence that pregnant patients who presented to the ED with non-medical complaints were entered in the ED Central Log.

Interviews with Staff #1, Staff #2 and Staff #4 in the morning of 05/17/11 revealed that pregnant patients who were sixteen - twenty-four (16-24) weeks gestation presenting to the ED with obstetrical complaints were transferred to Labor and Delivery without being entered into the Central ED Log.

The facility's policy entitled "Triage of Pregnant Patients Who Present to the Emergency Department", dated 01/01/10, reveals that the ED nurse, after obtaining the chief complaint and patient's gestational age should call the L & D triage staff before sending the patient. The L & D staff must generate a "Triage Call Form".

There is no documented evidence that the ED staff communicated to the L & D Department when a patient was being escorted to the unit.

Interview with Staff #6 and Staff #7 in the L & D unit on the afternoon of 05/17/11 revealed that they consider their triage log the "Triage Call Form". However, the staff does not always document whether the patient was transferred from the ED in the comments section of the form.

Review of the current "Attending Administrative Manual" revealed that the ED staff will contact the L & D unit and inform them of the patient's name, private attending, length of gestation and presenting complaint prior to escorting the patient to L & D.




28406

2.) Based on interviews and review of the Emergency Department Central Log, the facility failed to maintain a comprehensive log that is accurate, complete and easily retrievable.

Findings:

The Central Emergency Department Log was requested on the morning of 05/16/11 but could not be provided. A second request was made at 1:30PM on 05/16/11 for printouts of five (5) randoms dates: 02/10/11, 03/10/11, 04/06/11, 05/06/11 and 05/07/11, which was not available until 05/17/11, the next day.

An interview with Staff #13 on 05/17/11 at 10:20AM revealed that the facility does maintain an Emergency Department Log however, it cannot be viewed on request.

On 05/17/11 at 10:30AM, a request was made for the ED Central Log dated 05/15/11 which was provided at 2:30PM, four (4) hours after it was requested.

Review of the ED Log revealed no entries for the disposition status of patients in five (5) out of six (6) requested dates. The log lacked the date, time and disposition of multiple patients on 02/10/11, 03/10/11, 04/06/11, 05/06/11 and 05/07/11.

This finding was confirmed on interview with Staff #13 on 05/18/11 at 11:30AM.
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