HospitalInspections.org

Based on observation in the Emergency Department at Prince George Hospital Center in the lobby and ambulance entrance, the hospital failed to conspicuously post EMTALA signage. In the lobby of the hospital on July 14, 2015 at 8:50am the surveyor noted an EMTALA Notice about 11 " x 8 " (bold black letters on white paper) posted at waist level at the registration desk and the signage in the ambulance bay area is not visible if a curtain is drawn. For both of these areas the signage is not visible as evident by hospital staff search for minutes with the surveyors to find the signage. In addition in the L&D suite there was no EMTALA signage although many patients are directly admitted to this area and registration will come from the ED to this area to register patients. The hospital failed to post signage in places likely to be noticed by individual ' s entering the Emergency Department and failed to post signage in the to the Labor & Delivery suite to inform patients of their rights regarding EMTALA.

Based on a review of medical records and other documentation along with interviews with staff during a survey at Bowie Health Center (BHC) conducted on 7/14/15, it was determined that the facility's transfer policy is not as specific as actual practice and does not sufficiently address the transfer of critically-ill patients.

BHC is the provider-based off-campus free-standing emergency care provider for the hospital. Every patient requiring any level of hospital admission has to be transferred to a hospital. The receiving hospital is determined by the patient's medical condition and level of care needed, patient preference, or the need for specialized services. If the preferred receiving hospital has no appropriate beds, is on emergency department or ICU re-route, or otherwise lacks the capacity to receive a critically ill patient, the patient is to be transferred to Prince George's Hospital Center emergency department.

In reviewing the policy entitled "Transfers from BHC to Other Healthcare Facilities," dated 10/8/13, during the survey on 7/14/15, it was noted that the policy did not provide guidance or time limitations for how many phone calls should be made to try to find an appropriate receiving hospital for critically ill patients. The policy also did not define a time limit for making calls and waiting for call-backs before sending the patient to the on-campus emergency department at the hospital.

During an interview on 7/14/15, the Medical Director of BHC described a "three-strikes" rule, whereby the BHC physician may make up to three calls to find a receiving hospital before sending the patient to the on-campus ED.

Review of quality data at BHC on 7/14/15 revealed an event from 2014 in which a BHC physician called five or six hospitals before finding one that had the capacity to care for a critically ill patient who ultimately died before transport arrived. Interviews with other BHC leadership on 7/14/15 confirmed that the three-strikes rule was implemented following that event.

While a medical record review of 20 patients chosen from the list of transfers for April 2015 showed no delays associated with calling multiple receiving hospitals, failing to incorporate such an important rule into written policy places other patients at risk for a delay in transfer.