HospitalInspections.org

Based on medical record review, staff interviews, and observation, the hospital failed to provide appropriate emergency services and interventions to all emergency room patients from the time the patient arrived at the facility to the time the patient was given an emergency room assignment.


Findings:


1. On February 8, 2016, at 1:20 p.m., surveyors toured the emergency department (ED). Surveyors observed ambulance service providers arriving at the ambulance entrance of the ED with patients and patients taken to emergency department rooms.


2. On February 8, 2016, at 1:43 p.m., surveyors observed an ambulance arrive at the ED and paramedics bring the patient on a stretcher into the ED. Surveyors observed the paramedics sit with the patient in the hallway until 1:46 p.m. At 1:46 p.m., the patient was taken to an ED room.


3. On February 8, 2016, at 1:46 p.m., the ED director told surveyors when an ambulance brought a patient into the ED and the patient had not been assigned a room the ambulance service providers (paramedics and Emergency Medical Technicians (EMT's) would sit with the patient in the hallway until the patient had a room assignment. The ED director told surveyors the patient was not considered admitted to the ED until the patient had a room assignment.


4. On February 8, 2016, at 1:46 p.m., Staff Q, an EMT, told surveyors when patients were brought to the ED via ambulance the patient is brought into the ED via stretcher and when there was no room assignment for the patient the EMT's and/or paramedics sit in the hall with the patient. Staff Q told surveyors he had waited up to one hour for a patient room assignment. Staff Q told surveyors the EMT's and paramedics end charting on the patient upon arrival to the ED not upon arrival to an ED room.


5. On February 8, 2016, at 2:00 p.m., Staff G, an ED Registered Nurse (RN), told surveyors EMT's and/or paramedics were to never leave a patient until a nurse assumes the care of the patient. Staff G told surveyors the nurse did not assume care of the patients until the patient was in an ED room.


6. On February 8, 2016, at 2:15 p.m., a paramedic told surveyors the ambulance services brought patients to the ED and the paramedics and/or EMT's brought the patient into the ED via stretcher and would wait in the hallway until an ED room assignment was made. The paramedic told surveyors the paramedics and/or EMT's monitor the patient but did not render patient care. The paramedic told surveyors he had waited up to 45 minutes with a patient in the hallway before the patient had a room assignment.


7. On February 8, 2016, at 2:30 p.m., Staff H, an ambulance service supervisor, told surveyors when patients were brought to the ED via ambulance the paramedics and/or EMT's brought the patient into the ED and would take the patient to the room that was assigned but if there was no room assignment the paramedics would sit with the patient in the hallway. Staff H told surveyors the paramedics would not render patient care but would get a nurse if the patient's condition changed. Staff H told surveyors the paramedics quit documenting on the patient's record at the time of arrival to the ED. Staff H told surveyors the paramedics could post an addendum to the ambulance record if the patient's condition changed. Staff H told surveyors not all paramedics would document an addendum in the record. Staff H told surveyors he had waited up to 2 hours in the hallway with a patient before the patient had a room assignment.


8. On February 9, 2016, at 11:00 a.m., the Senior Vice President told surveyors she was unaware that nobody documented interventions or vital signs on the patient when patients were brought into the ED via ambulance and paramedics sat with a patient in the hallway.


9. On the afternoon of February 9, 2016, surveyors reviewed twenty one ED patient medical records. All twenty one ED patient medical records were from patients who had been brought to the ED via ambulance. All twenty one ED patient medical records contained no documentation of any vital signs, and interventions from the time the patient was brought in to the ED until the patient was given an ED room assignment. The medical records documented the period of wait time from arrival to the ED to patient room assignment varied from 4 minutes up to 2 hours and 41 minutes.