HospitalInspections.org

Based on review of records and interviews, the hospital did not comply with 489.24, in that:

1. The hospital did not provide an appropriate medical screening examination to determine an emergency medical condition for 1 of 3 pregnant patients (Patient #1), who presented to the emergency department (ED) during March 2010.

The ED record of Patient #1 showed that the hospital did not provide a vaginal examination or determine status of the fetus.
Cross Refer to Tag A2406

2. The hospital did not provide further medical examination and treatment, within their capability, to stabilize the medical condition for 1 of 3 pregnant patients (Patient #1) who presented to the emergency department (ED) during March 2010.

The ED record of Patient #1 showed no diagnostic tests, such as ultrasound, was provided to determine labor and/or condition of fetus. In a telephone interview with the Director of Radiology (Personnel #6), the morning of 05/10/10, he was asked if ultrasound was available to the ED. He responded that there was a rolling ultrasound machine available for use in the ED 24 hours a day.

Cross Refer to Tag A2407

Based on review of records, and interviews, the hospital did not provide an appropriate medical screening examination to determine an emergency medical condition for 1 of 3 pregnant patients (Patient #1), who presented to the emergency department (ED) during March 2010.

The ED medical record for Patient #1 noted the following:
-The patient presented to the ED at 1800 on 03/16/10, with a chief complaint of "Pregnant- 9 months, vaginal bleeding," and triage level was marked "emergent." Estimated due date was 4 days previous, and had no prenatal care for the previous 5 months.
-The patient gave a history of "2 weak contractions, lasting from 3 to 5 seconds each, in the previous 2 hours," and reported "bright red blood when she went to the restroom."
-The nursing record showed "no contractions," and external pelvic "vaginal bleeding."
-The emergency physician did not perform a vaginal examination, or determine fetal heart tones (FHTs).
-No ultrasound was performed.

No examination to determine presence of labor and FHT's was provided for Patient #1.
Patient disposition was transfer to another hospital for "Uterine bleed -pregnant."

In a telephone interview with an ED nurse (Personnel #7) the morning of 05/10/10, the surveyor asked what the usual routine is for assessing pregnant patients. He stated that the assessment includes vaginal examination by the physician, and that fetal heart tones are obtained either through the use of a doppler or by ultrasound.

In an interview the morning of 05/06/10 with the ED physician, (Personnel #5), he was asked if he had provided Patient #1 with a vaginal examination. He said "no," as he "was not going to do anything definitive anyway, like delivering the baby." He stated that this hospital had no obstetric services, and that he had arranged for a transfer of this patient to their sister hospital where those specific services were available. When asked if he had obtained fetal heart tones on the fetus during his medical screening examination, he said "no," as their doppler was not working when he tried to use it.

In a telephone interview with the Director of Radiology (Personnel #6), the morning of 05/10/10, he was asked if a doppler or ultrasound machine was available to the ED. He responded that there was a rolling ultrasound machine available for use in the ED 24 hours a day.

Based on review of records and interviews, the hospital (Hospital A) did not provide further medical examination and treatment, within their capability, to stabilize the medical condition for 1 of 3 pregnant patients (Patient #1) who presented to the emergency department (ED) during March 2010.

The ED medical record for Patient #1, from Hospital A, noted the following:
-The patient presented to the ED at 1800 on 03/16/10, with a chief complaint of "Pregnant- 9 months, vaginal bleeding," and triage level was marked "emergent." She also reported a frontal headache and low back pain.
-The patient gave a history of "2 weak contractions, lasting from 3 to 5 seconds each, in the previous 2 hours," and reported "bright red blood when she went to the restroom."
-The nursing record showed "no contractions," and external pelvic "vaginal bleeding." Blood pressure was 146/96; no treatment was provided.
-The emergency physician record did not perform a vaginal examination, and did not determine fetal heart tones (FHTs). The clinical impression was "vaginal bleeding and elevated blood pressure," with no diagnostic tests or examination, and/or no treatment provided.
-There was no ultrasound (sonogram) performed.
-Patient disposition was transfer to another hospital for "Uterine bleed -pregnant."

In a telephone interview with an ED nurse (Personnel #7) the morning of 05/10/10, the surveyor asked what the usual routine is for assessing pregnant patients. He stated that the assessment includes vaginal examination by the physician, and that fetal heart tones are obtained either through the use of a doppler or by ultrasound.

In an interview the morning of 05/06/10 with the ED physician, (Personnel #5), he was asked if he had provided Patient #1 with a vaginal examination. He said "no." When asked if he had obtained fetal heart tones on the fetus during his medical screening examination, he said "no."

In a telephone interview with the Director of Radiology (Personnel #6), the morning of 05/10/10, he was asked if diagnostics were available to the ED to determine fetal heart tones and/or contractions. He responded that there was a rolling ultrasound machine available for use in the ED 24 hours every day.

The ED medical record for Patient #1, from Hospital B, noted the following:
-Patient #1 presented at Hospital B 33 minutes past leaving Hospital A.
-On admit to Hospital B the patient received a vaginal examination that noted "Dilitation at 0.0, Effacement at 25, and Station at -3, membrane intact." FHT's noted to be 135 baseline rate, and positive fetal movement.





Hospital A routinely provides sonograms for medical screening. It was noted that Patients # 2 & 3 who presented with pregnancy related problems received sonograms during their ED visits in March 2010.