HospitalInspections.org

Based on medical record review, review of a security video, review of facility policy, and interview, the facility failed to provide a medical screening examination and stabilizing treatment for one patient (#5) of twenty-eight patients reviewed.

The findings included:

Refer to A-2406 for failure to provide a medical screening examination.

Refer to A-2407 for failure to provide stabilizing treatment.

Based on medical record review, review of a security video recording, facility policy review, and interview, the facility failed to provide a medical screening examination for one patient (#5) of twenty-eight patients reviewed.

The findings included:

Patient #5 presented to the Emergency Department (ED) on 3/2/15 at 11:09 AM for heavy vaginal bleeding.

Medical record review revealed the patient was thirty-seven weeks pregnant. Continued medical record review revealed the patient left the ED at 11:34 AM (25 minutes after arrival) without being triaged by a nurse or a physician.

Review of a security video recording dated 3/2/15 revealed the patient's husband approached the registration window four times during the 25 minute period and spoke to a registration clerk before leaving with the patient.

Review of facility policy, Medical Screening of the Obstetrical Patient, dated April, 2014, revealed "...it is the policy...to provide a medical screening examination to all obstetrical [pregnant] patients presenting for unscheduled obstetrical evaluation...patients presenting with obstetrical complaints will receive an obstetrical screening examination in the Emergency Department...when trauma and/or medical conditions that are emergent in nature are present in the pregnant patient an assessment will be completed in the Emergency Department...any OB [obstetrical/pregnant] patient greater than or equal to 20 weeks gestation with obstetrical problems should be triaged for medical screening..."

Interview with Registration Clerk #1 on 3/30/15 at 9:40 AM, at the registration desk, revealed "...tracking board signals the triage nurse [a patient needs to be seen]...[Registration Clerk] will call back to the desk if triage nurse is with someone else...will wait a couple of minutes if someone doesn't come...will call again...or get up and go back there [nurses station]..."

Interview with Registered Nurse (RN) #2 on 3/31/15 at 11:44 AM, in the ED conference room, revealed she was the triage nurse on 3/2/15. Further interview revealed "...was with another patient...I noticed her chief complaint...went to call her...ER [Emergency Room] clerk said she had just left...said she [the patient] was upset and left...I was with another patient in the back...generally shift leader is aware of the flow and will look and see if people need to be attended to...[ED registration staff] will let us know if they can when someone is leaving...as soon as she left I had the ER clerk call one of her [patient] numbers and I tried the other number...there was no answer..."

Interview with ED Physician #1 on 3/31/15 at 12:55 PM, in ED room 12, revealed "...can see patients waiting in the lobby on the tracking board...at times we have nurse bring patient on back...can't always watch the tracking board but try...oh yeah she [patient] is someone who would of needed to come back...wouldn't need to wait..."

Telephone interview with RN #1 on 3/31/15 at 7:22 PM, revealed "...was shift leader that day...no one told me...I don't remember anything about this...I can't believe someone would be out there that long and no one would triage her...I watch that [tracking] board if someone is not being triaged I will go...registration is not good at letting us know if someone is leaving..."

Telephone interview with ED Physician #2 on 3/31/15 at 7:34 PM, revealed he was the ED physician on 3/2/15. Further interview revealed "...I don't remember anything about her...don't remember anyone telling me about her leaving...we defer to the triage nurse about who comes back..."

Telephone interview with Registration Clerk #2 on 3/31/15 at 8:00 PM, revealed she was the ED registration clerk on 3/2/15. Continued interview revealed "...I do remember her...she came in...sat down...her husband registered her...she was waiting about 25 minutes...I remember noting that she had been there for 25 minutes after her husband registered her...it was at least 25 minutes...they were both at the window at first...he came back up to the window and questioned the wait...I told him the nursing staff would be with them as quickly as they could...a triage nurse was there...but I don't know where she was...didn't see her the whole time...he [patient's husband] told me they were leaving...I told the triage nurse they had left...after they left she told me to call the patient and ask them to come back...I didn't make the phone call because another patient came in...the triage nurse called about 15 minutes later...no one answered...the third time he [patient's husband] came to the desk was when he said they were leaving...the other times he came he questioned the wait...normally we just apologize for the wait...if someone is extremely critical we are told to go get the nurse...that would be like a heart attack...I went back there and couldn't find her [triage nurse]...it was routine that we can't find anyone to come out to triage...that happens so often that we don't have anyone in triage...I remember how upset and worried he [patient's husband] was..."

Interview with the ED Nurse Manager on 3/31/15 at 12:17 PM, in the ED conference room, revealed "...patients to be triaged...expectation is within five minutes...shift leader should be watching the board...shift leader could be with a patient...[shift leader] would be watching the tracking board...should be trying to get free and get out there [triage]...registration will call back if someone is in a lot of distress...they will come back and get someone...whoever they see...they would tell we have a bad patient out there...if they [patient] are pregnant and having some type of problem they shouldn't be put back in the lobby...could use hall beds..." Further interview confirmed the patient did not receive a medical screening examination.

Based on medical record review, review of a security video recording, facility policy review, and interview, the facility failed to provide stabilizing treatment for one patient (#5) of twenty-eight patients reviewed.

The findings included:

Patient #5 presented to the Emergency Department (ED) on 3/2/15 at 11:09 AM for heavy vaginal bleeding.

Medical record review revealed the patient was thirty-seven weeks pregnant. Continued medical record review revealed the patient left the ED at 11:34 AM (25 minutes after arrival) without being triaged by a nurse or a physician.

Review of a security video recording dated 3/2/15 revealed the patient's husband approached the registration window four times during the 25 minute period and spoke to a registration clerk before leaving with the patient.

Review of medical records from hospital #2 revealed the patient arrived on 3/2/15 at 12:10 PM and was admitted for observation until 7:25 PM. The patient was diagnosed with a possible small placenta abruptio.

Review of facility policy, Medical Screening of the Obstetrical [pregnant] Patient, dated April, 2014, revealed "...it is the policy...to provide a medical screening examination to all obstetrical patients presenting for unscheduled obstetrical evaluation...patients presenting with obstetrical complaints will receive an obstetrical screening examination in the Emergency Department...when trauma and/or medical conditions that are emergent in nature are present in the pregnant patient an assessment will be completed in the Emergency Department...any OB [obstetrical/pregnant] patient greater than or equal to 20 weeks gestation with obstetrical problems should be triaged for medical screening..."

Interview with Registration Clerk #1 on 3/30/15 at 9:40 AM, at the registration desk, revealed "...tracking board signals the triage nurse [patient needs to be seen]...[Registration Clerk] will call back to the desk if triage nurse is with someone else...will wait a couple of minutes if someone doesn't come...will call again...or get up and go back there [nurses station]..."

Interview with Registered Nurse (RN) #2 on 3/31/15 at 11:44 AM, in the ED conference room, revealed she was the triage nurse on March 2, 2015. Further interview revealed "...was with another patient...I noticed her chief complaint...went to call her...ER [Emergency Room] clerk said she had just left...said she [the patient] was upset and left...I was with another patient in the back...generally shift leader is aware of the flow and will look and see if people need to be attended to...[ED registration staff] will let us know if they can when someone is leaving...as soon as she left I had the ER clerk call one of her [patient] numbers and I tried the other number...there was no answer..."

Interview with ED Physician #1 on 3/31/15 at 12:55 PM, in ED room 12, revealed "...can see patients waiting in the lobby on the tracking board...at times we have nurse bring patient on back...can't always watch the tracking board but try...oh yeah she [patient] is someone who would of needed to come back...wouldn't need to wait..."

Telephone interview with RN #1 on 3/31/15 at 7:22 PM, revealed "...was shift leader that day...no one told me...I don't remember anything about this...I can't believe someone would be out there that long and no one would triage her...I watch that [tracking] board if someone is not being triaged I will go...registration is not good at letting us know if someone is leaving..."

Telephone interview with ED Physician #2 on 3/31/15 at 7:34 PM, revealed he was the ED physician on 3/2/15. Further interview revealed "...I don't remember anything about her...don't remember anyone telling me about her leaving...we defer to the triage nurse about who comes back..."

Telephone interview with Registration Clerk #2 on 3/31/15 at 8:00 PM, revealed she was the ED registration clerk on 3/2/15. Continued interview revealed "...I do remember her...she came in...sat down...her husband registered her...she was waiting about 25 minutes...I remember noting that she had been there for 25 minutes after her husband registered her...it was at least 25 minutes...they were both at the window at first...he came back up to the window and questioned the wait...I told him the nursing staff would be with them as quickly as they could...a triage nurse was there...but I don't know where she was...didn't see her the whole time...he [patient's husband] told me they were leaving...I told the triage nurse they had left...if someone is extremely critical we are told to go get the nurse...that would be like a heart attack...I went back there and couldn't find her [triage nurse]...it was routine that we can't find anyone to come out to triage...that happens so often that we don't have anyone in triage...I remember how upset and worried he [patient's husband] was..."

Interview with the ED Nurse Manager on 3/31/15 at 12:17 PM, in the ED conference room, revealed "...patients to be triaged...expectation is within five minutes...shift leader should be watching the board...shift leader could be with a patient...[shift leader] would be watching the tracking board...should be trying to get free and get out there [triage]...registration will call back if someone is in a lot of distress...they will come back and get someone...whoever they see...they would tell we have a bad patient out there...if they [patient] are pregnant and having some type of problem they shouldn't be put back in the lobby...could use hall beds..." Further interview confirmed the patient did not receive a stabilizing treatment and should have been seen by a physician.