HospitalInspections.org

Roger Williams Hospital (RWH) failed to ensure compliance with the Emergency Medical Treatment and Labor Act requirements related to the following:

1. Failure to maintain a central log (a log maintained by the hospital on each individual who comes to the Dedicated Emergency Department; ED) for a patient who presented to the ED with complaints of vaginal bleeding and abdominal pain, following a medical procedure (A-2405).

2. Failure to ensure that a comprehensive medical screening examination (MSE) was performed on a patient who presented to the Emergency Department (ED) with complaints of vaginal bleeding and abdominal pain, following a medical procedure (A-2406).

3. Failure to ensure a patient was stable for transport, and the receiving facility was notified in writing of the patient's medical condition and the need for continued care (A-2409).

Based on record review and staff interview, it has been determined that the hospital failed to maintain a central log (a log maintained by the hospital on each individual who comes to the Dedicated Emergency Department; ED) for a patient who presented to the ED with complaints of vaginal bleeding and abdominal pain, following a medical procedure, for 1 of 25 patients reviewed who presented to the hospital's ED for treatment, (Patient ID #1).

Findings are as follows:

Record review of the hospital's Emergency Department Daily Log was completed on 3/19/2025. The Daily Log contained documentation of all patients who entered the Emergency Department from September 2024 to March 17, 2025. Patient ID #1 did not appear in the log on 3/14/2025.

During a surveyor interview with the Employee K and Employee G on 3/19/2025 at 10:30 AM, they acknowledged that Patient ID #1 presented to RWH ED on 3/14/2025 and was not registered into the ED Daily Log Sheet as required. Additionally, Employee K acknowledged that the Hospital's Electronic Medical Record failed to contain evidence that the patient had presented to the hospital's Emergency Department on 3/14/2025.

Based on record review and staff interviews, it has been determined that the hospital failed to ensure that a comprehensive medical screening examination (MSE) was performed on a patient who presented to the Emergency Department (ED) with complaints of vaginal bleeding and abdominal pain, following a medical procedure, for 1 of 20 patients reviewed who presented to the hospital's Emergency Department for treatment. (Patient ID #1).

Findings are as follows:

A review of the EMS Patient Care Report sheet dated 3/14/2025 revealed the following information:

Dispatch Date and Time: 3/14/2025, 03:32 AM
Arrival to Destination: 3/14/2025, 3:56 AM, at RWH
Depart time: 3/14/2025, 4:07 AM; from RWH
Arrival at Destination: 3/14/2025, 4:25 AM; to Hospital B

During a surveyor interview with Staff B, on 3/19/2025 at 3:00 PM in the presence of the Staff K and the Staff F, she revealed that she was on duty at RWH on the night of 3/14/2025. Staff B indicated that she remembered being called out of a patient room and was informed by Staff A, that Patient ID #1 was brought in for abdominal pain and vaginal bleeding.

Additionally, she was informed by Staff A that the patient had previously underwent a procedure at Hospital B and so Staff B thought that the patient should go back to that hospital because RWH does not provide those services during the night. Staff B then stated that the patient was "stable" and she determined this by "eyeballing" the patient, indicating that she did not conduct an examination of the patient. Furthermore, Staff B acknowledged that she did not call Hospital B to inform them that the patient was enroute to them and was unaware if EMS had done so, stating "how would I know that."

During a surveyor interview with the Staff F on 3/19/2025 at 3:30 PM he explained that he would have expected that the patient would have been registered as an ED patient, triaged, and evaluated by the ED physician. He indicated that a medical screening exam should have been performed, and then the patient should have been transferred to Hospital B if needed. Staff B acknowledged that the attending physician failed to follow the hospital's EMTALA policy and conduct a comprehensive medical screening examination on Patient ID #1 prior to his/her transfer to another acute care hospital.

During a surveyor interview with Staff C, on 3/20/2025 at 7:30 AM, she explained that she was not at the charge desk when Patient ID #1 arrived in the ED. She revealed that she observed EMS and Staff A speaking with Staff B. She indicated that EMS wanted to take Patient ID #1 to Hospital B based on his/her complaints, but the patient insisted on going to RWH. It was then determined that EMS would then take the patient to Hospital B, and they left. Staff C stated that she "was shocked" that Staff B would just let EMS take the patient and acknowledged that the hospital's registration and triage policy was not followed.

During a surveyor interview on 3/20/2025 at 11:05 AM with Staff A, she stated that on the night of 3/14/2025, the rescue stopped at her desk and so she told them that she would receive the patient. She indicated that EMS believed that the patient had a previous surgical procedure at the RWH, however, upon reviewing the patient's discharge paperwork from two nights prior, she realized that the patient was seen in RWH ED previously for abdominal pain and bleeding, and was advised at that time, to return to Hospital B or the outpatient facility where the medical procedure had been performed. Staff A indicated that she usually reviews any paperwork provided by EMS, and then decides if the patient needs to be roomed or go to the express area or go to the waiting room. Staff A stated that the doctor, Staff B then came over and asked the patient if they had their Procedure at Hospital B, and the patient nodded his/her head "yes" while still on the stretcher, and she asked the doctor if she wanted EMS to bring the patient to Hospital B. Staff A was unable to explain why she deviated from the normal triage process by not registering the patient. Staff A acknowledged that she did not follow the proper protocol for this patient and then stated that the patient was on hospital grounds, inside of the hospital, but was "still on the ambulance stretcher" when the decision to divert the patient to Hospital B was made.

Based on record review and staff interview, it has been determined that the hospital failed to ensure a patient was stable for transport, the receiving facility was notified in writing of the patient's medical condition and the need for continued care, for 1 of 25 patients reviewed who presented to Roger Williams Hospital (RWH) Emergency Department for treatment. As a result, the patient was transferred to another acute care hospital without a Medical Screening Examination in accordance with federal regulations, which had the potential to jeopardize the patient's health and well-being, (Patient ID #1).

Findings are as follows:

During a surveyor interview with Staff B on 3/19/2025 at 3:00 PM, in the presence of the Staff K and Staff B, she revealed that she was on duty at RWH the night of 3/14/2025. Staff B indicated that she remembered being called out of a patient room and was informed by Staff A, that Patient ID #1 was brought in for increased abdominal pain and vaginal bleeding. Additionally, she was informed by Staff A that the patient had previously underwent a medical procedure at Hospital B and thought that the patient should go back to that hospital because RWH does not provide those services during the night. Staff B then stated that the patient was "stable" which she had determined by "eyeballing" the patient, indicating that she did not examine the patient. Furthermore, Staff B, acknowledged that she did not call Hospital B to inform them that the patient was enroute to them and was unaware if EMS had done so, stating "how would I know that."

During a surveyor interview with Staff F on 3/19/2025 at 3:30 PM, he revealed that he would have expected that the Patient ID #1 would have been registered as an ED patient, triaged, and evaluated by the ED physician when s/he arrived at the hospital's emergency department. Additionally, he revealed that a medical screening examination should have been performed prior to the patient's transfer to ACH-B. He acknowledged that RWH failed to document Patient ID #1's arrival in RWH emergency room.