HospitalInspections.org

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Based on interview, record review, document review, and review of the hospital's policies and procedures, the hospital failed to ensure adequate and qualified staff for the provision of emergency care.

Failure to provide adequate and qualified staff for the delivery of emergency care places patients at risk for delays in treatment and suboptimal outcomes.

Findings included:

1. Failure to assume care of patients seeking emergency services.

Cross-reference A 1112

Due to the scope and severity of deficiencies cited under 42 CFR 482.55, the Condition of Participation for Emergency Services WAS NOT MET.
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Based on observation, interview, and document review, the hospital failed to accept care of patients arriving by ambulance and provide a triage and continual monitoring at the time of arrival on hospital property in 4 of 26 patients reviewed (Patients #5, #10, #13, #14).

Failure to ensure timely triage, monitoring, and prioritization of the medical screening exam (MSE) risks delays in treatment and suboptimal outcomes.

Findings included:

1. Review of the hospital's policy titled, "Emergency Medical Treatment & Labor Act (EMTALA)," policy number 10953975, last approved 11/2021, showed that a triage determines that order or prioritization of patients for MSE. MSE is a continuous process of ongoing monitoring and treatment until the patient is stabilized, transferred, or discharged.

Review of the hospital's policy titled, "Emergency Nursing Standards & Process of Care," policy number 13510429, last revised 05/2023, showed that all patients are to be evaluated by a registered nurse (RN) upon arrival to the emergency department (ED).

2. The investigator reviewed medical records and prehospital patient care records (PCRs) for patients who received care in the ED with the ED Manager (Staff #11). The documentation showed the following:

PATIENT #5

a. Emergency medical services (EMS) documentation showed that Patient #5 arrived at the ED via ambulance on 12/02/23 at 9:17 PM. The patient was brought to the ED due to altered mental status, suicidal ideation, and intoxication. Hospital documentation showed that Patient #5's arrival to the ED was acknowledged by ED staff at 9:21 PM. The patient remained in the ED under EMS care until a nurse assumed care and triage began on 12/03/23 at 1:39 AM, 4 hours and 18 minutes after the patient arrived in the ED. Evidence of patient care or monitoring before 1:39 AM could not be found.

PATIENT #10

b. EMS documentation showed that Patient #10 arrived at the ED via ambulance on 12/15/23 at 6:13 PM for alcohol intoxication. Hospital documentation showed that Patient #10's arrival to the ED was acknowledged by ED staff at 6:17 PM. The patient remained in the ED under EMS care. EMS documentation showed that the EMS staff anticipated caring for the patient in the ED for 3 or more hours due to ED staffing. An ED technician took vitals at 7:42 PM and a nurse assumed care of the patient at 9:31 PM, 3 hours and 14 minutes after the patient arrived in the ED. Evidence of patient care or monitoring before 9:31 PM could not be found.

PATIENT #13

c. EMS documentation showed that Patient #13 arrived at the ED via ambulance on 01/04/24 at 11:37 PM for a near syncope (fainting) episode. Hospital documentation showed that Patient #13's arrival to the ED was acknowledged by hospital staff at 11:41 PM. The patient remained in the ED under EMS care until a nurse assumed care on 01/05/24 at 12:59 AM, 1 hour and 18 minutes after the patient arrived in the ED. Evidence of patient care or monitoring before 0059 AM could not be found.

PATIENT #14

d. EMS documentation showed that Patient #14 arrived at the ED via ambulance on 12/12/23 at 10:27 PM for acute intoxication. Hospital documentation showed that Patient #14's arrival at the hospital was acknowledged by ED staff at 10:40 PM. The patient remained in the ED under EMS care until a nurse assumed care on 12/13/23 at 12:21 AM, 1 hour and 41 minutes after the patient arrived in the ED. Evidence of patient care or monitoring before 12:21 AM could not be found.

3. On 02/27/24 at 10:40 AM, the investigator interviewed the ED charge nurse (Staff #4). Staff #4 confirmed the practice of having EMS staff take care of their patients in the hallway until a nurse was available to assume care and that this could be a lengthy wait at times.

4. On 03/01/24 at 11:30 AM, the investigator reviewed Patient #5, #10, #13, and #14's medical records with the ED manager (Staff #11). Staff #11 confirmed the patients' arrival times in relationship to the times they began to receive care by hospital staff.
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