HospitalInspections.org

Based on review of documents and staff interview, the hospital failed to ensure compliance with Section 489.24 (b). The hospital failed to ensure all patients presenting to the Emergency Department (ED) were logged in (see Tag A-2405), and failed to ensure all patients are triaged and provided a medical screening examination (see Tag A-2406).

Based on review of documents and staff interview the ED failed to log-in one (1) of one (1) patients reviewed who presented to the ED via ambulance. This omits having any record of the patient being in the ED and has the potential to limit the care rendered to the patient. Findings include:

1. A review of The Jan Care Emergency Medical Services (EMS) Trip Sheet (dated 9/3/2010) indicated Patient #1 was taken to Beckley ARH Hospital (BARH's) ED at approximately 9:25 a.m. The Trip Sheet also indicated (in part) that the BARH ED Clinical Nurse Manager "had no issue with taking the patient but ..... the House Nurse Supervisor made a call to her supervisor and said that this patient was not to be brought here but was to go to RGH because that is where he was discharged from. It was the Nursing Supervisors who made the decision not the Clinical Nurse Manager".

2. A review of the ED Registration Log for September, 2010 revealed patient #1 (who presented in the ED via ambulance) was not entered on the log. There was no evidence of any documentation that any form of care was rendered to the patient.

3. During a telephone interview with the ED Clinical Manager in the morning of 9/14/10, she stated she thought the patient should have been treated while in the ED but the House Nursing Supervisor said to send the patient to Raleigh General Hospital (RGH) and thus the patient was not entered in the ED log.

4. The above findings were reviewed with the Chief Nursing Officer on 9/14/10 in the a.m. and she agreed with the findings.

Based on review of documents and staff interview, the hospital failed to triage one (1) out of one (1) patients and failed to perform a medical screening examination (patient #1). This has the potential to limit the quality of patient care and prevent a determination as to whether (or not) the patient had an emergency medical condition. Findings include:

1. Upon interview (on 9/13/10 in the morning) with the Emergency Medical Technician (EMT) who transported patient #1 to Beckley ARH's Emergency Department (ED) on 9/3/10 he stated the patient was brought inside the ED by Emergency Medical Services (EMS) personnel.

2. A review of the Jan Care Emergency Medical Services (EMS) Trip Sheet (dated 9/3/2010) indicated Patient #1 was taken to Beckley ARH Hospital (BARH's) ED at approximately 9:25 a.m. The Trip Sheet also indicated (in part) "the House Nurse Supervisor made a call to her supervisor 'in Administration' .... and said that this patient was not to be brought here but was to go to RGH because that is where he was discharged from. It was the Nursing Supervisor who made the decision 'to send the patient out' not the Clinical Nurse Manager". Thus the ED did not triage the patient nor perform a medical screening examination and a medical record was not generated.

3. The ED Clinical Nurse Manager agreed during a telephone interview in the morning of 9/13/10, the patient was not triaged or medically screened. She indicated she would have kept the patient here but felt she needed to follow her supervisors' direction and "send the patient to RGH" (Raleigh General Hospital).

4. During telephone interview with the House Nursing Supervisor in the morning of 9/14/10, she indicated she was a "little fuzzy" as to what the EMTALA expectations were at the time, so she called Administration for guidance while the patient was in the ED; she said she was told "to send the patient to RGH". The Nursing Supervisor could not recollect whether or not she told Administration the patient was already in the ED.

5. During interview with the Risk Manager in the afternoon of 9/13/10 he said, when he told the Nurse Supervisor to send the patient to RGH, he thought the patient had not yet arrived but was still in route. The Nursing Supervisor could not recollect whether or not she told Administration the patient was already in the ED.

6. These findings were reviewed with the Assistant Administrator in the morning of 9/14/10 and he agreed with the findings.