HospitalInspections.org

Based on MR review, in 20 of 20 MR (1 through 20), tour and observation, the facility failed to ensure MRs include MD notification of patients arrival, transfer forms are complete and including Pt specific risk of transfer, MD to MD contact, and completion of AMA forms; and EMTALA signs are missing.

Findings include:

In 1 of 1 tour, the facility failed to ensure an EMTALA sign is in the patient/family waiting room. See Tag A2402.

In 6 of 6 MRs, the facility failed to ensure the transfer form and/or MR includes: documentation of MD to MD contact, date and time of transfer consent, and risks of transfer specific to the Pt condition. See Tag A2409.

The cumulative affect of these deficiencies potentially affect all 125 ED Pts, and 94 Urgent Care Pts seen during survey.

Based on tour of the facility and interview with staff (A and H), in 1 of 1 tour, the facility failed to ensure EMTALA signs are posted in Pt waiting areas. This deficiency potentially affects all 125 ED Pts and 94 Urgent Care Pts treated at the facility during survey.

Findings include:

Per tour of the facility ED on 3/4/13 at 10:45 AM with DPCS A and DED H, and in interview during the tour on 3/4/13 at 10:45 AM, DPCS A and DED H agree there is no EMTALA sign in the waiting room of the ED across from the registration area.

Based on MR review and interview with staff (A), in 6 of 6 ED MRs (3, 4, 7, 14. 15 and 16), out of a universe of 20 MRs, the facility failed to ensure transfer consent documentation includes risks and benefits specific to the patient condition, dates and times; and/or there is documentation of MD consent by the receiving facility. This deficiency potentially affects all 125 ED Pts and 94 Urgent Care Pts treated at the facility during survey.

Findings include:

Per interview with DPCS A on 3/5/12 at 10:00 AM, "all transfers should have a MD to MD contact documented in the MR, and all entries need to be dated and timed."

Pt #3's MR reviewed on 3/4/13 at 3:15 PM revealed Pt #3 arrived in the ED on 2/6/13 at 8:12 PM complaining of chest pain. The MR indicated Pt #3 is diagnosed with a heart attack and required transfer to a "higher level of care". There is no documentation of a MD to MD consult with the receiving facility to confirm acceptance of the Pt. The transfer document dated 2/6/12 at 8:30 PM states under risks of transfer a generic statement "Transportation problems (traffic delays, accidents with injury or death, inclement weather, vehicle limitations, rough terrain, etc.) Delays in receiving definitive treatment. Deterioration of condition up to and including death. Limitations of equipment and personnel present in vehicle." There is nothing specific to Pt #3's cardiac condition with risk of transfer on the transfer document or in the MD notes. This is confirmed in interview and discussions with DPCS A on 3/4/13 at 4:00 PM.

Pt #4's MR reviewed on 3/4/13 at 2:45 PM revealed Pt #4 arrived in the ED on 2/4/13 at 2:32 PM complaining of shortness of breath and cough. The MR indicated Pt #4 is diagnosed with Acute Respiratory Failure and required transfer to a "higher level of care", due to no open ICU bed. There is no documentation of a MD to MD consult with the receiving facility to confirm acceptance of the Pt. The transfer document dated 2/4/12 at 4:20 PM states under risks of transfer a generic statement "Transportation problems (traffic delays, accidents with injury or death, inclement weather, vehicle limitations, rough terrain, etc.) Delays in receiving definitive treatment. Deterioration of condition up to and including death. Limitations of equipment and personnel present in vehicle." There is nothing specific to Pt #4's respiratory condition with risk of transfer on the transfer document or in the MD notes. This is confirmed in interview and discussions with DPCS A on 3/4/13 at 4:00 PM.

Pt #7's MR reviewed on 3/5/13 at 6:30 AM revealed Pt #7 arrived in the ED on 1/3/13 at 11:02 AM complaining of chest pressure. The MR indicated Pt #7 is diagnosed with Chest Pain and required transfer to a "higher level of care", due access to appropriate medical equipment not available at the facility. There is no documentation of a MD to MD consult with the receiving facility to confirm acceptance of the Pt. The transfer document dated 1/3/13 at 11:40 AM states under risks of transfer a generic statement "Transportation problems (traffic delays, accidents with injury or death, inclement weather, vehicle limitations, rough terrain, etc.) Delays in receiving definitive treatment. Deterioration of condition up to and including death. Limitations of equipment and personnel present in vehicle." There is nothing specific to Pt #7's cardiac condition with risk of transfer on the transfer document or in the MD notes. This is confirmed in interview and discussions with DPCS A on 3/5/13 at 10:00 AM.

Pt #14's MR reviewed on 3/4/13 at 3:20 PM revealed Pt #14 arrived in the ED on 11/1/12 at 11:30 PM complaining of chest pain. The MR indicated Pt #14 is diagnosed with Acute Coronary Syndrome and required transfer to a "higher level of care", due to no availability of specialized equipment. The transfer document dated 11/2/12 at 1:54 PM states under risks of transfer a generic statement "Transportation problems (traffic delays, accidents with injury or death, inclement weather, vehicle limitations, rough terrain, etc.) Delays in receiving definitive treatment. Deterioration of condition up to and including death. Limitations of equipment and personnel present in vehicle." There is nothing specific to Pt #14's respiratory condition with risk of transfer on the transfer document or in the MD notes. This is confirmed in interview and discussions with DPCS A on 3/4/13 at 4:00 PM.

Pt #15's MR reviewed on 3/4/13 at 3:25 PM revealed Pt #15 arrived in the ED on 10/5/12 at 10:02 PM complaining of exhaustion, need of shower and brush his teeth. The MR indicated Pt #15 is diagnosed with Paranoid Schizophrenia and required transfer for continuity of care. The transfer document dated 10/5/13 at 11:50 PM states under risks of transfer a generic statement "Transportation problems (traffic delays, accidents with injury or death, inclement weather, vehicle limitations, rough terrain, etc.) Delays in receiving definitive treatment. Deterioration of condition up to and including death. Limitations of equipment and personnel present in vehicle." There is nothing specific to Pt #15's psychiatric condition with risk of transfer on the transfer document or in the MD notes. This is confirmed in interview and discussions with DPCS A on 3/4/13 at 4:00 PM.

Pt #16's MR reviewed on 3/4/13 at 3:30 PM revealed Pt #16 arrived in the ED on 10/4/12 at 1:44 PM complaining of chest pain. The MR indicated Pt #16 is diagnosed with Acute Coronary Syndrome and required transfer due to continuity of care, and unavailability of specialized equipment. There is no documentation of a MD to MD consult with the receiving facility to confirm acceptance of the Pt. The transfer document is not dated or timed. This is confirmed in interview and discussions with DPCS A on 3/4/13 at 4:00 PM.