HospitalInspections.org

Based on document reviews and staff interviews, it was determined the hospital does not maintain an accurate ED (Emergency Department) central log which includes each individual who comes to the hospital seeking assistance and emergency care.

Findings include:

During a survey conducted on February 19 - 21, 2014, the staff was asked to provide the ED central log of all patients who required emergency care. The facility was unable to provide a central log that included all patients.

On February 21, 2014 at 3:00 PM, Staff #1 provided a log and stated it was the hospital's central EMTALA (Emergency Medical Treatment and Labor Act) log. A review of the log revealed it contained only a list of obstetric patients and did not include the names of all patients that had presented to the emergency room for emergency care. In addition, the chief complaint section on the log was listed in a coded format

Based on reviews of the facility's policies and procedures, Medical Staff Bylaws and Rules and Regulations, medical records, and physician interview, it was determined that the facility failed to provide an appropriate medical screening examination within the capabilities of the facility for 3 of 8 sampled obstetric patients. (Patients #24, #40 and #41)
Findings include:
A review of medical record #40 on February 21, 2014 revealed the patient is an eighteen year old primigravida (first pregnancy) who presented to the facility on February 4, 2014. According to nursing documentation at 5:36 PM the patient complained of decreased fetal movement since 1:00 PM that day. The patient had a previous medical history of Asthma and Sickle Cell Trait. The presenting vital signs were temperature 96.9F, pulse 80, respiration 16 and a B/P (blood pressure) of 129/62 at 5:30 PM. The patient's membrane was intact. An electronic fetal monitoring (efm) was started according to documentation at 5:40 PM. This entry also revealed the physician was notified of the patient and of the results of the tracing and that the patient had "still verbalized she doesn't feel the baby move." A biophysical profile ( a test that measures the health of a baby during pregnancy) was ordered.

Documentation at 5:51 PM in the medical record revealed the patient was sent for an ultrasound which was completed by 6:25 PM. The patient still reported that she did not feel the baby move.
Additional documentation in the medical record revealed the nurse again spoke to the physician and told her that the patient insisted that she did not feel the baby move. This was documented at 6:50 PM that day. At 7:05 PM the nurse spoke to the physician and gave her the result of the biophysical profile and that the patient "insists that she did not feel the baby move, asked md (doctor) to speak to patient, and connected to patient room." The physician spoke to the patient and according to documentation at 7:12 PM the physician called back the nurse and instructed the nurse that "the patient was ok to go home, to go to Planned Parenthood tomorrow."

The patient returned to the hospital the following day, February 22, 2014, because the staff at the Planned Parenthood clinic instructed her to return to this hospital for an induction of labor because she had passed her delivery date.
A review of patient # 41's medical record on February 21, 2014 revealed this is a twenty three year old pregnant patient who presented to the hospital on February 2, 2014 at 3:40 PM with a complaint of abdominal pain. The patient's vital signs were temperature 97F, pulse 100, respirations were 15 breaths per minute and the B/P was 120/77. The fetal heart rate was 145. The patient was placed on a monitor, an intravenous access was obtained, and a vaginal examination was performed by a nurse. The biophysical profile revealed the patient was 33.6 weeks pregnant. The patient was sent home that day without an appropriate screening examination.
A review of patient #24 medical record on February 21, 2014 revealed that this is a thirty-two year old patient who presented on February 17, 2014 at 12:15 AM with abdominal cramping for approximately 24 hours. The cramping had started at midnight on February 16, 2014. The patient had been sent from the ED triage to the obstetric unit. The patient was "G1P0 (first pregnancy with pregnancy that has gone to delivery ) ?EDC (Estimated Date of Conception)" and she reported that she had engaged in sexual intercourse on February 15, 2014. The patient had not had any prenatal care and a due date had not been confirmed.

The patient denied vaginal bleeding. The patient's vital signs were temperature 97.5F, pulse 74, respiration 17 and B/P 117/73. A urine specimen was collected. No palpable contractions were felt and the fetal heart rate was 145. A physician was notified by phone of the findings and he instructed the nurse to discharge the patient with instructions to follow-up in a clinic on February 18, 2014. The patient was discharged at 1:05 AM that morning. There was no documentation of the patient's gestational age or evidence that the patient received an appropriate medical screening examination from a qualified medical practitioner.

During interview Staff # 6 on February 19, 2014 at 11:00 AM, Staff #6 stated that patients that present to the ED with gestational age that exceeds 20 weeks are sent to the obstetric unit.

During an interview which was conducted on February 20, 2014 at 2:55 PM, Staff #2, the nurse acknowledged that a physician did not examine the above patients during the patient ' s visits.

During interview with Staff #3, the Medical Director of the hospital stated on February 20, 2014 at approximately 3:15 PM that only a physician can perform a medical screening examination and determine the disposition of the patients that present to the emergency department.

A review of the medical staff bylaws on February 20, 2014 revealed that the bylaws do not specify which category of staff may conduct a medical screening examination.

On February 20, 2014 a review of the Rules and Regulations for the Department of OB/GYN including its own bylaws were reviewed. While these regulations narrated the admissions process for the antenatal patient, they did not specify the level of staff credentialed to perform a medical screening examination in Obstetrics.