HospitalInspections.org

Based on findings from medical record review and interview, for one of 12 patients (Patient #1) the emergency department (ED) care did not meet generally accepted standards due to delay in the physician care provided. A surge in ED patients is reported to have contributed to the delay.

Findings:

-- Review of Patient #1's medical record by a board certified emergency physician reveals the following: Patient #1 presented to the ED at 21:25 with complaint of severe abdominal pain associated with nausea and vomiting that started that day. Patient was cooperative, but anxious and agitated at triage. Pain located in left lower and right lower quadrants. Vital signs stable. Past medical history: asthma, pyloric stenosis, ulcer disease, stomach surgery, hernia repair. Nursing documentation indicates the patient complained of increased pain in abdomen and was observed crying on the floor of the ED waiting room at 23:53. Oral medications were given for pain and nausea, approximately after midnight. At 01:13, critical lab value for white blood cell (WBC) count of 32.5 was reported by laboratory. At 02:20, approximately 5 hours after arrival, the patient underwent physical examination by the ED physician. Surgery consultant was contacted approximately 7 hours after arrival. The patient was taken to the operating room for exploratory laparotomy for perforated gastric ulcer. While the evaluations and diagnostic testing done were appropriate, these time intervals represent delay in care. The standard of care was not met in this regard.

-- Per interview at 7:00 am on 12/10/13 with the involved ED Charge Nurse, the ED was very busy when this patient was waiting for physician evaluation. He/she was in contact with the administrator on call about the situation and the ED was placed on diversion status (i.e., ambulances were requested to not bring patients to this ED unless a patient so demanded).