HospitalInspections.org

16399

Based on interview and review of the Emergency Department central log (ED log), it was determined that the facility did not ensure that it maintained a complete ED log as required.

Findings include:

Based on the facility's plan of correction, an electronic EMTALA log was implemented in March, 2011. The review of the electronic Emergency Department Log for August, September and October found that the facility is still not maintaining a complete ED Log. The surveyor found the August log had several gaps in the disposition column but the September and October logs had fewer missing entries.

Examples are:
MR #1
This patient was triaged on 8/1/11 at 1858 with complaint of abdominal pain. The medical record notes the patient walked out at 2058. The ED log omitted the disposition of the patient.

MR #2
The patient presented to the ED on 8/9/11 with complaint of insomnia and auditory hallucination. The patient was treated and discharged home. The disposition of the patient was not documented in the ED log.

MR #3
This patient was triaged on 8/1/11 at 1539 walked out of the ED on 2359. The medical record notes that the patient was a "voluntary walk out"; however, the disposition of the patient was omitted in the ED log.

Similar findings related to the omission of disposition of patients in the ED log included but were not limited to the following patients: MR #s 4 through 18.

At interview with the Associate Executive Director of Regulatory Affairs and the Director of Emergency Department on 10/11 and 10/12, they stated their computer system "Quadramed " was not capturing the disposition of all patients especially those that walked out before MD assessment. The problem was reported to The Health and Hospital Corporation (HHC) and is in the process of being fixed; in the meantime, the logs are reviewed and missing information is entered manually.

16399

Based on interview, it was determined that the facility plan of correction to assure timely reading of CT scans and to provide round the clock radiology coverage for ultrasound and Doppler testing and reading were not implemented.

Findings include:

The facility was previously cited for untimely and inaccurate reading of a CT scan of an infant with head trauma. The CT of an infant with head trauma was read as negative and the patient discharged, but approximately 6 hours later the facility that read the CT advised the hospital that a fracture was, in fact, found on the study. The hospital has a practice where CAT scans performed at the facility at night are read at night at another network facility by a resident and reviewed by an attending. The facility plan that will have all ED ordered CT scans read by an Attending Radiologist with the use of a contracted provider has not been implemented as at 10/12/11. The facility's completion date for this plan was 10/15/11. Also, the plan to provide 24 hours 7 day a week radiology coverage for ultrasound and Doppler testing and reading has not been fully implemented. The completion date for this plan was 10/1/11.

At interview with the Associate Executive Director of Regulatory Affairs and the Director, Emergency Department on 10/11, they noted the completion of both plans were delayed by the processes involved with contract negotiation and hiring of staff. A draft contract for radiology coverage submitted to HHC is in the process of approval. The hiring of staff for radiology coverage for ultrasound and Doppler has begun but not completed. The tentative date for the implementation of both plans is in early December, 2011.