HospitalInspections.org

Based on a tour of the ED (Emergency Department) and staff interview, conducted on November 25, 2014 at approximately 10:00 AM, it was determined that the facility failed to conspicuously post signage specifying the rights of individuals under section 1867 of the Act, with respect to examination and treatment for emergency medical conditions and women in labor or information indicating whether or not the hospital participates in the Medicaid program.

Findings include:

1. Observation of the main entrance to the facility revealed no signage posted.

2. Observation of the ED Triage Room revealed no signage posted.

3. Observation of the ED treatment bays revealed no signage posted.

4. The above findings were confirmed by Staff #5.

Based on review of ED on call lists, it was determined that the facility failed to ensure that a physician on call list which identifies the name of an individual physician on call for all specialties, is maintained.

Findings include:

1. Review of the on call list for a Cardiology Specialist revealed that a physician group was listed as on call for June 2014 through November 2014.

2. The above finding was confirmed by Staff #3.

Based on medical record review, staff interview, and review of facility policies and procedures, it was determined that the facility failed to ensure that all patients that come to the ED receive an appropriate medical screening examination.

Findings include:

Reference #1: Facility policy titled "Emergency Medical Treatment & Active Labor Act (EMTALA)" states under Procedure, " ... 2. Triage A. Staff will triage all patients. Triage is undertaken on a "first come, first serve" basis, but in all cases is subject to the apparent severity of the conditions of those presenting to the Emergency Department at any given time... 3. Medical Screening Exam (MSE) A. Except in the case of a scheduled service (for example, diagnostic testing and occupational medicine visits) or direct admissions, staff will provide all patients with a Medical Screening Examination. This examination shall be performed by a physician or other practitioner (e.g. Nurse Practitioner, Physician's Assistant) deemed qualified to perform such examination pursuant to state law and the acute care hospital's Rules and Regulations. ..."

Reference #2: Facility policy titled "Triage Procedures and Guidelines" states under Procedure, "A. Triage assessment shall include the rapid, systematic collection of data related to the patient's chief complaint, vital signs and basic personal information. Each patient will receive a triage evaluation to determine the seriousness of the patient's condition and the urgency of care. B. The triage assessment shall determine which patient care area is best suited for each patient and whether each patient needs immediate intervention, quick interventions, or will not be harmed by delayed intervention (if necessary) ... "

Reference #3: Facility policy titled "Patient's Wishing to Leave Prior to Medical Screening/Treatment (LWOT)" states under Procedure, " ... G. When a patient enters the Emergency Department seeking medical attention or advice and then changes his/her mind prior to being triaged, a record of that visit must be initiated. A nursing record with the patient's name, age and the notation that the patient left prior to triage must be made. These patients will be considered as Left Without Being Seen (LWBS). An attempt should be made to document the complaint, reason for leaving, and the patient's ability to make such a decision using the sign in sheets and witness accounts from staff in the reception area. The patient's name and any other available information must be entered into the official Emergency Department electronic Log..."

1. Medical Record #1 revealed the following:

a. A 45 year old female arrived at the ED on 8/26/13 at 2332 with the chief complaint of "Symptoms of stroke by domestic violence."

b. The patient left the ED at 2:16 AM on 8/27/13 after 2 hours and 44 minutes.

c. There was no evidence that the patient was triaged to determine the seriousness of the patient's condition and the urgency of care.

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

2. Medical Record #10 revealed the following:

a. A 36 year old male arrived at the ED on 8/11/14 at 2121 with the chief complaint of "Jaw Pain/Dental Pain."

b. The patient left the ED at 2231 PM on 8/11/14 after 1 hour and 10 minutes.

c. There was no evidence that the patient was triaged to determine the seriousness of the patient's condition and the urgency of care.

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

3. Medical Record #13 revealed the following:

a. A 40 year old female arrived at the ED on 5/12/14 at 1908 with the chief complaint of "Shortness of Breath."

b. Triage was completed at 2023 and the patient was given the classification level, "4- Non Urgent."

c. The patient left the ED at 5:11 AM on 5/13/14.

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

4. Medical Record #14 revealed the following:

a. A 51 year old female arrived in the ED on 9/15/14 at 0148 AM with the chief complaint of "fall."

b. The patient left the ED at 0230 AM on 9/15/14 after 42 minutes.

c. There was no evidence that the patient was triaged to determine the seriousness of the patient's condition and the urgency of care.

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

5. Medical Record #15 revealed that following:

a. A 55 year old female arrived at the ED on 8/27/13 at 2340 with the chief complaint of "Severe stomach pain post op Hysterectomy."

b. The patient left the ED at 12:30 AM on 8/28/13 after 50 minutes.

c. There was no evidence that the patient was triaged to determine the seriousness of the patient's condition and the urgency of care.

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

6. Medical Record #16 revealed the following:

a. A 46 year old female arrived at the ED on 9/15/14 at 1:22 AM with the chief complaint of "Stomach Pain."

b. The patient left the ED at 7:02 AM on 9/15/14 after 5 hours and 40 minutes.

c. There was no evidence that the patient was triaged to determine the seriousness of the patient's condition and the urgency of care.

(i) Even though the patient was not triaged, the condition was documented as "Good" on the "Patient Discharge Information Sheet."

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

7. Medical Record #17 revealed the following:

a. A 59 year old male arrived at the ED on 3/5/14 at 17:55 AM with the chief complaint of "Knee Pain."

b. The patient left the ED at 1841 on 3/5/14 after 46 minutes.

c. There was no evidence that the patient was triaged to determine the seriousness of the patient's condition and the urgency of care.

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

8. Medical Record #18 revealed the following:

a. A 21 year old female arrived at the ED on 9/15/14 at 23:11 with the chief complaint of "Migraine."

b. The patient left the ED at 3:21 AM on 9/16/14 after 4 hours and 10 minutes.

c. There was no evidence that the patient was triaged to determine the seriousness of the patient's condition and the urgency of care.

(i) Even though the patient was not triaged, the condition was documented as "Good" on the "Patient Discharge Information Sheet."

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

9. Medical Record #29 revealed the following:

a. A 61 year old male arrived at the ED on 8/17/13 at 2040 with the chief complaint of "Knee Pain."

b. The patient left the ED at 1:11 AM on 8/18/13 after 4 hours and 31 minutes.

c. There was no evidence that the patient was triaged to determine the seriousness of the patient's condition and the urgency of care.

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

10. Medical Record #30 revealed the following:

a. A 40 year old female arrived at the ED on 8/27/13 at 2330 with the chief complaint of "Pain in chest, back pain."

b. The patient left the ED at 2352 on 8/27/13 after 22 minutes.

c. There was no evidence that the patient was triaged to determine the seriousness of the patient's condition and the urgency of care.

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

11. Medical Record #31 revealed the following:

a. A 4 year old female arrived at the ED on 9/15/14 at 2157 with the chief complaint of "Fever."

b. The patient left the ED at 3:23 AM on 9/16/14 after 5 hours and 26 minutes.

c. There was no evidence that the patient was triaged to determine the seriousness of the patient's condition and the urgency of care.

d. There was no evidence that a medical screening examination was completed to determine if an emergency medical condition existed.

12. The above findings were confirmed by Staff #11.

Based on staff interview, it was determined that the facility's ED 'quick registration' may deter patients from seeking treatment.

Findings include:

1. During interview with Staff #7, he/she stated that during the pre-registration phase, the patient is asked information which includes the patient's name, date of birth, address, reason for coming to the ED, driver's license, and for the patient to place their hand on the Handscanner.

2. Staff #11 stated that the Handscanner is a tool that allows the facility to read an individuals vein pattern to determine if they have previously been a patient at the facility. Staff #11 stated that it also allows the facility to determine if the patient has been at the facility under a different name. Staff #11 stated that each person's vein pattern is unique to each individual.

3. Asking for a driver's license and using the Handscanner during the pre-registration process is a possible deterrent to individuals seeking treatment. This procedure could discourage patients from remaining for further treatment.

Based on review of five (5) medical records of patients that were transferred to another facility, it was determined that the facility failed to ensure that all transfers are conducted appropriately.

Findings include:

Medical Record #8 failed to include the patient's condition on the EMTALA Transfer Request Form, at the time of transfer.