HospitalInspections.org

Based on observations and interview, the hospital failed to post conspicuously in the emergency department or in a place or places likely to be noticed by all individuals entering the emergency department, as well as those individuals waiting for examination, signs specifying the rights of individuals under section 1867 of the Social Security Act with respect to examination and treatment in the emergency room. Findings include:A tour of the hospital emergency department (ED) was conducted with Employee C/Emergency Department (ED) Administrator and Employee D/ED Nurse Manager on 4/27/15 at 2:05 p.m. The hospital had two entrances, including the main ED entrance to the waiting room and the ambulance entrance from the garage. There were no signs specifying the rights of individuals under section 1867 of the Social Security Act with respect to examination and treatment for emergency medical conditions and women in labor (EMTALA) in the entrance of the waiting room and no signs in the ambulance entrance from the garage where individuals may pass through to enter the ED and/or wait to be called into the ED. There were no EMTALA signs in the waiting room of the ED. There was one EMTALA sign at the entrance to the intake rooms where individuals may be triaged. The sign was printed in English only. The lack of signage at the waiting room entrance to the ED was verified with Employee C and Employee D on 4/27/15 at 2:12 p.m. The lack of signage at the ambulance entrance from the garage was verified by Employee C and Employee D at 2:52 p.m. Both employees acknowledged there were no informative signs at these waiting area entrances to the ED.

Based on documentation review and interview the hospital failed to maintain an accurate and complete central log for each individual who presented for emergency medical care for 5 of 8 pregnant patients (P15,P18, P19, P20, P21) reviewed. Findings include:

P15:
The obstetrics (OB) central log was reviewed and it indicated P15 presented to the hospital on 4/15/15 at 8:30 p.m. for preterm labor. The log did not include whether the patient was transferred, admitted and treated, stabilized and transferred, or discharged. P15's obstetrics record was reviewed and indicated P15 was discharged home.P18:
The OB central log was reviewed and it indicated P18 presented to the hospital on 2/20/15 at 8:00 a.m. for cramping. The log did not include whether the patient was transferred, admitted and treated, stabilized and transferred, or discharged. P18's obstetrics record was reviewed and it indicated P18 was discharged home.

P19:
The OB central log was reviewed and it indicated P19 presented to the hospital on 2/6/15 at 7:40 p.m. for possible spontaneous abortion. The log did not include whether the patient was transferred, admitted and treated, stabilized and transferred, or discharged. P19's obstetrics record was reviewed and it indicated P19 was discharged home.
P20:
The OB central log was reviewed and it indicated P20 presented to the hospital on 1/2/15 at 9:25 a.m. for fetal tacchycardia. The log did not include whether the patient was transferred, admitted and treated, stabilized and transferred, or discharged. P20's obstetrics record review indicated P20 was discharged home.

P21:
The OB central log was reviewed and it indicated P21 presented to the hospital on 4/17/15 at 4:23 p.m. for an ectopic pregnancy. The log did not include whether the patient was transferred, admitted and treated, stabilized and transferred, or discharged. P21's obstetrics record review indicated P21 was admitted to the hospital. An interview with RN-M on 4/28/15 at 10:20 a.m. verified the OB central log was incomplete related to the disposition of some of the patients.
An interview with Nurse O/nurse manager on 4/28/15 at 2:35 p.m. verified the log was incomplete for many patients, especially if the patient was discharged to home after being triaged, assessed, had a medical screening examination, and was treated. An interview on 4/28/15 at 3:25 p.m.verified P15, P18, P19, and P20 discharged to home and P21 was admitted to the hospital. Nurse O stated effective 4/28/15 the OB central log was changed to reflect disposition for all patients seen in the OB triage area.