HospitalInspections.org

Based on observation and staff interview, it was determined that the facility failed to conspicuously post signage, specifying the rights of individuals under section 1866 of the Act with respect to examination and treatment of emergency medical conditions and women in labor.

Findings include:

1. A tour of the Access Center and Main Lobby revealed that there were no EMTALA signs posted in the following areas:

a. Hospital main entrance/Lobby

b. Access Center entrance

c. Access Center ambulance entrance

d. Access Center Triage Room

e. Access Center Exam Rooms #1 and #2

f. Access Center Consult Rooms #1 and #2

g. Access Center Family Lounge

h. The Access Center Waiting Room had signage behind the seating area making it difficult for patients and visitors to visualize.

2. These findings were confirmed with Staff #1 and Staff #2.

Based on medical record review, review of facility policies and procedures, and staff interviews, it was determined that the facility failed to ensure patients receive an appropriate medical screening exam (MSE), which includes appropriate classification from the admissions clinician based on emergent needs and urgency of care.

Findings include:

Reference #1: Facility policy, Medical Screening, Stabilization and Transfer of Patients in Access and Admission, states, "... will provide a medical screening examination to any individual who presents to Access ... to determine if a an emergency medical condition exists ... Triage: ... When an individual presents and requests a need for care, the Admissions Clinician ... shall initiate the triage procedure as noted on the form CC-IA Triage 997A ..."

Reference #2: Facility policy, Admission Procedures, states, "... Triage: Patients arriving at the facility by any route will be triaged to assess the presence of emergent needs and urgency of care ..."

1. Upon review of Medical Record #12, the following was noted:

a. The patient presented to the Access Center on 12/22/2018 at 2258 with a complaint of bipolar disorder and panic attacks.

b. The patient was triaged at 2318 and classified as UR (Urgency of Care).

c. The patient left the Access Center at 2345.

d. The patient did not have an MSE that was completed by a qualified medical professional.

2. Upon review of ten (10) of twenty (20) Medical Records (#5, #7, #8, #9, #10, #13, #15, #16, #17, and #19), the following was noted:

a. The patients were triaged.

b. The presence of emergent needs and urgency of care was not documented.

3. Upon review of Medical Records #3, #11, and #16, the following was noted:

a. The triage form was incomplete.

4. The above findings were confirmed with Staff #1.

A. Based on medical record review, review of facility policy and procedure, and staff interviews, it was determined the facility failed to ensure all patients are notified of the risks of a transfer.

Findings include:

Reference: Facility policy, Medical Screening, Stabilization and Transfer of Patients in Access and Admissions, states, "Transfer: ... Physician Certification. ... The certification must contain a summary of the risks and benefits upon which it is based. ..."

1. Upon Review of Medical Record #1, the following was noted:

a. The patient was transferred to [name of facility] on 1/12/19 at 1941.

b. The patient was not notified of the risks of the transfer.

2. Upon Review of Medical Record #2, the following was noted:

a. The patient was transferred to [name of facility] on 1/26/19 at 0945.

b. The patient was not notified of the risks of the transfer.

3. The above findings were confirmed with Staff #1.

B. Based on medical record review, review of facility policy and procedure, and staff interviews, it was determined that the facility failed to ensure patient's consent to transfer prior to transferring out of the Access Center.

Findings include:

Reference: Facility policy, Medical Screening, Stabilization and Transfer of Patients in Access and Admissions, states, " ... Transfer: ... At the time of transfer, [name of facility] sends to the receiving hospital ... Informed written consent ..."

1. Upon Review of Medical Record #13, the following was noted:

a. The patient was transferred to [name of facility] on 1/17/19 at 1509.

b. The patient or legally responsible individual did not give informed written consent to be transferred.

2. The above finding was confirmed by Staff #1.

C. Based on medical record review, review of facility policy and procedure, and staff interviews, it was determined the facility failed to ensure all patients who are transferred have an accepting physician at the receiving hospital.

Findings include:

Reference: Facility document, Consent to Transfer form, states, " ... Transfer Requirements ... The receiving hospital has agreed to accept and to provide appropriate necessary medical treatment and has available space and personnel. ... Accepting Physician: ..."

1. Upon Review of Medical Record #1, the following was noted:

a. The patient was transferred to [name of facility] on 1/12/19 at 1941.

b. The patient did not have an accepting physician at the receiving hospital.

2. Upon Review of Medical Record #10, the following was noted:

a. The patient was transferred to [name of facility] on 1/13/19 at 2004.

b. The patient did not have an accepting physician at the receiving hospital.

3. Upon Review of Medical Record #11, the following was noted:

a. The patient was transferred to [name of facility] on 1/26/19 at 2028.

b. The patient had an accepting nurse practitioner at the receiving hospital.

c. The patient did not have an accepting physician at the receiving hospital.

4. Upon Review of Medical Record #17, the following was noted:

a. The patient was transferred to [name of facility] on 10/6/18 at 2003.

b. The patient had an accepting advanced practice nurse at the receiving hospital.

c. The patient did not have an accepting physician at the receiving hospital.

5. Upon Review of Medical Record #18, the following was noted:

a. The patient was transferred to [name of facility] on 2/16/19 at 1330.

b. The patient had an accepting physician's assistant at the receiving hospital.

c. The patient did not have an accepting physician at the receiving hospital.

6. The above findings were confirmed by Staff #1.

D. Based on medical record review, review of facility policy and procedure, and staff interviews, it was determined the facility failed to ensure that the APRN consults with the physician, if the physician is not physically present at the time of transfer, and that the physician countersigns the certification as soon as possible.

Findings include:

Reference: Facility policy, Medical Screening, Stabilization and Transfer of Patients in Access and Admissions, states, " ... Transfer: ... Physician Certification. A physician (or APRN [Advanced Practice Registered Nurse] after consultation with the physician if the physician is not physically present at the time of transfer) ... If an APRN signs the certification, the physician must countersign the certification as soon as possible. ..."

1. Upon review of eight (8) of eight (8) Medical Records (#1, #2, #3, #9, #10, #13, #18, and #20), the following was noted:

a. An APRN signed the physician certification.

b. There is no documented evidence that the APRN consulted with the physician.

c. The physician did not countersign the certification.

2. The above findings were confirmed by Staff #1.

E. Based on medical record review, review of facility policies and procedures, and staff interview, it was determined that the facility failed to ensure that patients requiring care that can be provided by the facility, are not transferred to another facility.

Findings include:

Reference #1: Facility policy, Medical Screening, Stabilization and Transfer of Patients in Access and Admissions, states, "... Transfers From Other Facilities: ... shall not refuse to accept an appropriate transfer of an individual requiring any specialized capabilities of facilities it has available. ..."

Reference #2: Facility policy, Commitment Procedures, states, "... Commitment of a Person in the Access Center: Any person who arrives in the Access Center who is in need of psychiatric hospitalization but is refusing voluntary treatment will be evaluated for voluntary commitment. ..."

Reference #3: Facility policy, Imminent Danger and/or Disruption Posed by Blake and Non-Patients, states, " ... 8. If involuntary commitment is necessary, the following procedures will be followed: a. A telephone call will be placed ... requesting Mobile Screening ... b. The Admission LIP (licensed independent practitioner) and one additional Attending Staff Psychiatrist shall both complete a Clinical Certificate for Involuntary Commitment ..."

1. Upon review of Medical Record #1, the following was noted:

a. Patient #1 was accepted by the facility as a transfer from [name of facility].

b. Patient #1 was transferred to the facility via ambulance on 1/12/19.

c. Patient #1 was assessed by the APRN upon arrival to the facility.

d. Patient #1 was transferred back to [name of facility] without a receiving physician.

2. Upon interview, Staff #1 stated, " ... When the patient was assessed, the APRN realized the patient was involuntary. The APRN should have started the involuntary commitment process."

3. The above findings were confirmed by Staff #1.

F. Based on medical record review, review of facility policy and procedure, and staff interview, it was determined that the facility failed to ensure that during transfers, patients are accompanied by appropriately qualified personnel.

Findings include:

Reference: Facility policy, Medical Screening, Stabilization and Transfer of Patients in Access and Admissions, states, "... During the transfer, the patient shall be accompanied by appropriately qualified personnel ..."

1. Upon review of three (3) of three (3) Medical Records (#2, #3, and #14), the following was noted:

a. The patient's were transferred to another facility.

b. The patient's were transported to the facility by family.

c. During transfer, the patients were not accompanied by appropriately qualified personnel.

2. The above findings were confirmed with Staff #1.