HospitalInspections.org

Based on document review and interview, the facility failed to follow their staffing matrix to supply the Emergency Department (ED) with the number of registered nurses (RN's) and nursing assistant/technicians (techs) required to provide adequate patient care for one (1) of one (1) Emergency Department (ED).

Findings include:

1. The hospital policy titled "Staffing Plans Policy", PolicyStat ID 11047011, indicated the plan was to provide quality nursing care and desired patient outcomes. Each staffing plan will be evaluated annually. This policy was last approved 02/2022.

2. The 2022 Emergency Department (ED) Staffing Plan Matrix, indicated the following:
a. Registered Nurses (RN's) - five (5) staffed - (7am-9am), (9am-11am), (11pm-3am) and (3am-7am)
b. RN's - seven (7) staffed - (11am-3pm) and (3pm-11pm)
c. Techs - one (1) staffed - (7am-9am), (9am-11am), (11pm-3am) and (3am-7am)
d. Techs - two (2) staffed - (11am-3pm) and (3pm-11pm)

3. Review of the one week staffing pattern worksheet indicated the facility was short staffed (RN's/Techs) on the following days/shifts:
a. Sunday May 8, 2022 - ED had no tech for evening shift and four (4) RN's on night shift.
b. Monday May 9, 2022 - ED had four (4) RN's and no tech on night shift.
c. Tuesday May 10, 2022 - ED had no tech on night shift.
d. Wednesday May 11, 2022 - ED had no tech on night shift.
e. Thursday May 12, 2022 - ED had one (1) RN on the evening shift.
f. Friday May 13, 2022 - ED had no tech on the night shift.
g. Saturday May 14, 2022 - ED had no tech on the night shift.

4. In interview on 06/09/2022 at approximately 2:00 pm with administrative staff member A # 3 (Interim ED Manager) at H # 2 (Acute Care Hospital), confirmed the department was usually short staffed on nights. The departments standard was five (5) RN's and one (1) Nursing Assistant (Tech). That night (Sunday-05/08/2022) we only had four (4) RN's and no Nursing Assistant (Tech).

Based on document review and interview, the registered nurse failed to ensure a patient was triaged in a timely manner per policy in one (1) instance. (Patient # 13)

Findings include:

1. The hospital policy titled, "Triage Standard", PolicyStat ID 11803603, indicated the patient should expect to be triaged upon entering the emergency care system to ensure timely evaluation and determination of priorities of care. This policy was last revised in 05/2022.

2. The hospital policy titled, "Emergency Department Triage and Assessment Policy", PolicyStat ID 5825543, indicated all patients presenting to the Emergency Department (ED) will be seen by a triage nurse prior to registration. This policy was last revised in 08/2019.

3. Review of the medical record (MR) for patient # 13 indicated the following:
a. The patient arrived at the ED on 05/08/2022 at approximately 9:56 pm.
b. The arrival complaint was documented at 9:56 pm as vomiting.
c. The MR lacked triage documentation for the patient.
d. The patient left without being seen on 05/09/2022 at 1:05 am.
e. The MR computer documentation verbiage indicated the patient was dismissed on 05/09/2022 at 1:05 am.

4. In interview on 06/09/2022 at approximately 4:10 pm with nursing staff member S # 5 (Registered Nurse-RN/ED), confirmed the ED was short staffed that evening/night. All the rooms were full. Not sure why we didn't triage him/her.

5. In interview on 06/09/2022 at approximately 4:30 pm with administrative staff member A # 1 (Chief Nursing Officer-CNO), confirmed their computer system used the term dismissed when a patient leaves without being seen and was removed from the waiting room list.

Based on document review and interview, it was determined that 1 of 20 (Patient 13) medical records reviewed of patients who presented to the hospital requesting emergency services, the facility failed to ensure compliance with 489.24 in that the facility failed to provide a medical screening exam.

Findings Include:

See findings cited at 42 CFR 489.24, A2406.

Based on document review and interview, the facility failed to provide a medical screening exam for 1 of 20 patients. (Patient # 13)

Findings include:

1. Facility policy titled Emergency Department Triage and Assessment Policy last reviewed 8/22 states under procedure on page 2 of 5: "A. All patients presenting to the Emergency Department will be seen by a triage nurse prior to registration. A registered Nurse or Physician may serve in this capacity. B. The urgency of the presenting complaint is assessed during the medical screening examination performed by a qualified medical person in accordance with policy #ER-A-009 in determining whether a medical emergency does or does not exist."

2. Review of the medical record (MR) for patient # 13 indicated the following:
a. The patient arrived at the ED on 05/08/2022 at approximately 9:56 pm.
b. The arrival complaint was documented at 9:56 pm as vomiting.
c. The MR lacked triage documentation for the patient or a medical screening exam.
d. The patient left without being seen on 05/09/2022 at 1:05 am.

2. In interview on 06/09/2022 at approximately 4:10 pm with nursing staff member S # 5 (Registered Nurse-RN/ED), confirmed the ED was short staffed that evening/night. All the rooms were full. Not sure why the patient was not triaged.