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Based on record reviews and interview, the hospital failed to ensure patients presenting to the ED for treatment were documented in a central log for 1 (Patient #21) of 21 ED patients reviewed. This failed practice resulted in a lack of documentation from the patient encounter and subsequent inability to track the patient across the care continuum.

Findings:

On 01/24/22 at 1:00 PM, the surveyor reviewed the previous six months' entries in the ED log. Patient #21 was not listed for any ED visits during this time, despite the reported ED visit on 12/28/21.

During an interview on 01/25/22, Employee D described an incident in which a patient complaining of abdominal pain came to the ED during the PM shift. Employee D stated the patient was not logged in and did not receive a MSE.

Based on record reviews and interviews, the hospital failed to ensure a MSE was performed for all patients presenting to the ED requesting a MSE. This failed practice had the potential to result in a delay of treatment and deterioration of the patient's condition for 1 (Patient #21) of 21 patients reviewed that presented to the ED for a MSE.


Findings:

1. Policies

A. The surveyor reviewed a policy titled "KGF ED EMTALA and Medical Screening Guidelines Policy" which read in part:

"Purpose...to ensure an appropriate medical screening evaluation is given to any individual who presents to our facility."

"Registered Nurses may not determine independently whether a patient suffers from an EMC..."

"All patients shall receive a medical screening exam that includes providing all necessary testing and on call services within the capability of the hospital to reach a diagnosis."

B. The surveyor reviewed a policy titled "KGF ED Scope of Service Policy" which read in part:

"The patient population served by the Emergency Department consists of newborn, pediatric, adolescent, adult, and geriatric patients requiring or seeking medical care."

"All patients that present to Mercy Hospital Kingfisher's premises for a non-scheduled visit and are seeking care shall receive a medical screening exam by an Emergency Department provider or physician..."

"Emergency Department patients are then evaluated for response to treatment and are admitted, transferred for further treatment not provided by the hospital or discharged, with follow-up instructions as appropriate."


2. Interviews

A. On 01/25/22, the surveyor conducted an interview with Employee D. The surveyor asked under what conditions or circumstances would a patient presenting to the ED not receive a MSE. Employee D replied. "The MSE should never be missed." Employee D went on to describe an encounter (related to this complaint) in which a mother and her son came to the ED during the PM shift. Employee D stated the son complained of stomach pain, and his mother stated he was diagnosed with appendicitis prior to arrival at the ED. Employee D stated he/she told the mother that the facility did not have surgical services and he would need to go to a larger facility. He/she stated the mother was agreeable to this, and stated she would drive her son to another facility.

B. On 01/25/22, the surveyor conducted an interview with Employee C. Employee C stated there were no conditions or circumstances in which a patient would not receive a MSE, unless a patient left without being seen.