HospitalInspections.org

Based on findings from document review and interview, the hospital failed to comply with the requirements at 489.24 and related requirements at 489.20.

Please reference findings at Tag 2408.

Based on findings from document review, interview, and video surveillance review, the hospital did not facilitate the transport of a patient from outside the Emergency Department (ED) entrance into the ED which delayed triage, medical screening exam (MSE) and treatment. Specifically, in 1 of 20 (Patient #1) medical records (MRs) reviewed. This delay could lead to untoward patient outcomes.

Findings include:

-- Review of the facilty's policy and procedure titled "EMTALA - Screening, Stabilization, Management of Transfers and Recordkeeping; Reporting Suspected EMTALA Violations," last revised 9/1/17, indicated a medical screening examination and/or stabilizing treatment may take place within a dedicated ED or elsewhere on hospital property. Hospital property includes the main campus, hospital's parking lots, sidewalks and driveways, plus hospital departments or buildings that are within 250 yards of the hospital's main building.

-- Review of Patient #1's MR revealed the following:
EMS (Emergency Medical Services) documentation on 9/5/17 at 6:53 pm revealed EMS was called to the ED entrance after Patient #1's mother was told by hospital staff at the ED that they could not help bring her daughter (9-year-old female) into the ED following a fall off a swing. ED staff stated "no, they can't help" the patient needed to be brought in by stretcher, so the mother called 911 for assistance. Upon arrival, the patient was in the backseat of the mother's car located in the ambulance space outside the ED emergency doors. Patient #1 was placed in a cervical collar and secured on a pediatric-board, then placed on a stretcher and wheeled into ED.

-- Review of video surveillance of 9/5/17 at 6:30 pm revealed the following:
6:30 pm - Mother of Patient #1 entered the ED and spoke with the Staff A (Security Guard).
6:32 pm - The security guard then took the mother to speak with the triage nurse.
6:34 pm - Patient #1's mother was speaking with the triage nurse, then walked to the ED entrance.
6:34 pm - The Security Guard went inside the exam area and could not be seen.
6:36 pm - The Security Guard returned and spoke to Patient # 1's mother and explained something.
6:37 pm - The mother went back outside and returned to her vehicle.
6:50 pm - Local Fire Department truck arrived and talked with Patient #1 and her mother.
6:53 pm - EMS arrived, stabilized Patient #1 and placed her on a stretcher.
7:03 pm - EMS brought the patient into the ED.

There was a 33 minute delay for triage, medical screening exam (MSE) and treatment of Patient #1 from the arrival to the hospital property until EMS transported her into the ED.

-- Per interview of Staff A (Security Guard) on 9/12/17 at 11:08 am, Patient #1's mother presented to the ED and stated her daughter fell off a bridge at the park, hurt her back and has a lot of pain. Staff A spoke to the triage nurse who instructed him/her to inform the charge nurse. The charge nurse told Staff A "there is nothing we can do, it's a liability, you will have to call 911." He/she returned to the waiting room in the ED and informed Patient #1's mother she would have to call 911. The mother then went outside and called 911. He/she did not see any ED staff go outside to evaluate the patient.

-- Per interview of Staff B (RN Charge Nurse ED) on 9/12/17 at 11:25 am, a staff member came to him/her and explained a child had neck and back injuries after falling several feet onto her head. Staff B stated "he/she is not trained to extricate a patient from the car and felt it was best to call EMS. The patient had a potential neck and spine injury. It's not that we refused to treat the patient but felt it was the safest option for the patient." He/she did not inform the ED Physician of the circumstances involving this patient. Staff B was not aware of any ED staff evaluating the patient outside in their vehicle. Staff B also indicated the ED doesn't have the appropriate equipment to stabilize patients, no back boards are available in the ED and he would have to search through the EMS lockers to find equipment.

-- Per interview of Staff C (Medical Director ED) on 9/11/17 at 9:15 am, if a patient is in a car and requesting assistance, the Security Guards can assist. If it is due to medical reasons, a nurse would be notified. "With trauma cases, it can get tricky for legality issues, whether a provider should go outside." Sometimes they would call the resource center "911 to assist" for extra help or if EMS providers were on site they would ask for assistance. It all depends on where on the property the patient is. If someone was having a heart attack they would run outside and bring the patient in.

-- During interview of Staff D (Nurse Manager ED) on 9/12/17 at 1:53 pm, he/she indicated, there is always equipment available to stabilize a patient (e.g., cervical collar, back board). The ED providers are all trained to apply the cervical collar and backboard to stabilize a patient. He/she would not expect staff to call 911 for a patient on hospital property.