HospitalInspections.org

Based on record review and interview, the facility failed to ensure an adequate medical screening exam was performed and failed to stabilize 1 (#38) of 46 patient prior to transfer resutling in the potential for less than optimal outcomes. Findings include:

See specific tag:

C2406 Failure to provide an adequate medical screening exam and stabilization prior to transfer

Based on record review and interview, the facility failed to perform an adequate medical screening exam and failed to provide stabilizing treatment prior to transfer for 1 (#38) of 46 patients reviewed resulting in an unexpected pre-term birth and the potential for poor patient outcomes. Findings include:

Review of the medical record for Patient #38 on 3/11/2019 at 1430 revealed Patient #38 was a 25-year old female who was 29 weeks into her first pregnancy. She presented to the emergency department (ED) on 2/15/2019 at 2030 via private car with the complaint of contractions.

Physician Staff N dictated documentation from 2/15/2019 stated, ..."Presented to ED with 1-hour duration of intermittent contractions of the uterus. No bleeding...rate 1-2 minutes then contractions resolve and come back in 5 minutes...Physical examination: Gestational age of uterus identified. I did a pelvis examination...minimal cervical opening. There is no active dilatation or bleeding at this time...I do not see any amniotic fluid at this time. Assessment: Labor 29-week-prime. Plan: Discussed the case with ED physician as well as (Staff O-obstetrics [branch of medicine concerned with childbirth] physician from receiving hospital) who accepted the patient. At this time (CAH facility) doesn't have the facility for obstetrics (OB); hence, transfer is necessary. Benefits outweigh risk of transfer, benefits being early intervention of her labor pains. Harmful effect can be deterioration in condition including delivery which is low probability because of her priming nature. The patient will be transferred by ACLS (advanced cardiac life support) team with an RN (registered nurse) to (receiving facility)...fetal heart sounds are roughly 130-140."

Review of physician orders revealed orders present for a saline lock intravenous access and laboratory testing of blood for a CBC (complete blood count), comprehensive metabolic panel, quantitative HCG (human chorionic gonadotropin-a test to determine pregnancy and gestation), and a urinalysis (testing of the urine).

When interviewed on 3/12/2019 at 1131, Staff N stated he "sees 2-3 OB patients per year" and he did remember the patient as they did not receive many patients in labor at the facility. He stated the ED physician at the receiving hospital accepted the patient for transfer; however, he did not feel comfortable sending the patient until he had spoken with OB Physician Staff O at the receiving hospital. He further stated he was "certain I told the OB physician the patient was 29 weeks gestation and having contractions."

An interview was conducted with ED Clinical Advisor Staff C on 3/12/2019 at 0737. When queried as to if there were medications available to stop labor, Staff C stated, "It's always a judgment call by the physician regarding OB cases. Each case is individual...Medications are available to help stop labor, but I question if they should be given in the ED when we do not have the capability to adequately monitor both mother and baby." Staff C further stated that fetal heart tones were obtained using a hand held doppler and that they relied on the mother to time the contractions as there was no fetal monitoring belt for continuous monitoring of the fetal heart rate and length of contractions. Staff C said, "I have reviewed this case and would not have done anything differently."

Further review of the medical record and ambulance run sheet revealed that Patient #38 was transferred with an ACLS (advanced cardiac life support) certified nurse (Staff D) via ambulance as a Level II priority using lights and sirens. They left the facility at 2120 on 2/15/2019 and arrived at the receiving facility at 2137 on 2/15/2019. Staff D documented giving report in the OB department on 2/15/2019 at 2140. Upon examination at the receiving facility, Patient #38 was found to be fully dilated with bulging membranes. She delivered a viable male infant at 2204 on 2/15/2019.