HospitalInspections.org

Based on record review and interview, the facility failed to provide an appropriate medical screening examination to 1(#1) of 20 patients who presented in the emergency department (ED) on August 2, 2022.

Findings include:

Patient #1 was a 62-year-old female with a past medical history of hypertension, diabetes, back pain, and OSA (obstructive sleep apnea) who presents to the Emergency Department with complaints of headache, difficulty swallowing, bilateral arm heaviness, and bilateral leg edema.

A review of the physician's note revealed the following:

"Symptoms have been ongoing for over a month already. No focal extremity weakness was reported. Her doctors have also ordered a CT scan of her head. No chest pain or shortness of breath. The patient was stating she feels like something is stuck in her throat, but that has also been ongoing for a month. No other complaints. No history of DVT or PE. The patient presents as described in HPI physical exam. Clinically she is very well-appearing, and her vital signs are unremarkable. Her presentation was benign based on clinical exam and has been ongoing for over a month. The physician documented I do not think any emergent testing is indicated in ED tonight. Stable for discharge. She is tolerating all oral secretions and the head/neck exam was benign. Can follow-up outpatient. I counseled on the importance of outpatient follow-up and the risks of not doing so. Patient education and return precautions are given. Follow-up care was reviewed, and all questions were answered. The patient is medically cleared for discharge."


The documentation revealed the patient was discharged from the emergency room at 5:15 AM. Also, the documentation revealed there was no blood work or other diagnostic tests performed during this visit. The documentation revealed the patient was seen by Physician #19.

Further review of the documentation revealed that patient #1 sought treatment at a local Freestanding Emergency room (FEMC) on 08/02/2022 at 6:34 AM. The patient was assessed at the FEMC, and diagnostic testing was performed. The results of the testing revealed a critically elevated D-Dimer (a small protein fragment that is made when a blood clot is dissolved in the body), this test is used to determine a patient's risk for deep vein thrombosis, pulmonary embolisms, disseminated intravascular coagulation and/or stroke. A Computed Tomography Angiography (CTA) was used to determine if there is a disruption of blood flow in the lungs that could indicate a pulmonary embolism. It was determined there was no indication of a pulmonary embolism, however, the physician concluded the patient needed further workup. The documentation revealed the physician contacted the local hospital and requested the patient be admitted to the hospital for further workup. The patient was accepted as a patient and admitted to the hospital at approximately 10:20 AM on 08/02/2022, five hours after her discharge from the local Emergency Room earlier that morning.

A review of the patient's inpatient record history and physical for 08/02/2022 through 08/03/2022 revealed the following:

"Patient is a 62-year-old female with a history of CHF who presented to local free standing emergency room with chest pain Patient has been having chest pain for the past 3 months, intermittent and non-radiating. No inciting factor per patient. The patient described it as tightness. The patient denies any nausea, vomiting, chills, fevers, cough, or productive sputum. Family history reviewed. Noncontributory to this case.
Reason for Hospitalization: Chest pain.
Hospital Course

8/2/2022
Rule out-first troponin negative. The patient currently not having chest pain. Rechecking troponin, EKG. The patient is on telemetry. Continue aspirin. Check an A1C and lipid panel Chronic CHF (diastolic versus systolic)-patient with bilateral lower extremity edema (right greater than left, see below). The patient's last echo was about a year ago. The patient is currently on room air and not in exacerbation. We will give a one-time dose of Lasix 60 and order an echo. Lower extremity edema (right greater than left}-elevated O-dimer. CTA of the chest was negative for PE. Will order a right lower extremity ultrasound. Give Lasix also. Hypertension Type 2 diabetes with hyperglycemia-sliding scale insulin with Accu-Cheks CKD stage II-avoid nephrotoxic drugs Morbid obesity-encourage lifestyle modification
Disposition: Anticipate discharge within 24 hours.

8/3/2022
The patient was seen and examined by the physician this morning. Patient with chronic diastolic Congestive heart failure. Patient diuressed and edema improved remarkably. The patient was currently chest pain-free, troponins negative, EKG is within normal limits, and no DVT was seen on the lower extremity. Patient stable to be discharged and will follow up with her PCP"

Patient #1 was seen in the local hospital on 08/22/2022 at 5:15 am and discharged without blood testing or diagnostic testing. The patient then presented at the local Freestanding Emergency Room and had blood testing and diagnostic testing. The physician at the freestanding emergency room had the patient admitted to the local hospital where the patient had just left 5 hours earlier and was discharged.