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Based on observation, interviews and record reviews, this hospital failed to ensure they were in compliance with all EMTALA requirements under 42 CFR 489. The facility failed to obtain an accepting physician prior to sending the patient to another hospital in 1 of 20 patients (#1); and failed to post EMTALA signage in 2 of 4 areas (lower level acuity rooms and second patient waiting area) used by emergency room patients. This deficient practice has the potential to affect all patients seeking emergency medical treatment at this facility.

Findings include:

1) Observations during tour of the emergency department revealed no EMTALA signage in the treatment rooms or waiting area. (See tag 2402)

2) Pt. #1 was transferred to another hospital without the verbal consent to accept the patient by the physician at the receiving facility. (See Tag 2409)

Based on observation and interview, the facility failed to ensure EMTALA signs are posted in all patient waiting and emergency treatment areas in 2 of 4 patient care areas (waiting room following triage and low acuity patient rooms). This deficiency potentially affects all Emergency Department patients treated at this facility.

Findings include:

On 9/26/16 at 5:00 PM, while touring the Emergency Department Area accompanied by Director of Emergency Services A, noted a second waiting area used by patients after being initially assessed, there were no EMTALA signs noted. The Emergency department has 11 patient rooms designated for lower acuity patients, no EMTALA signs noted in the patient rooms.

An interview was conducted with Director of Emergency Services A on 9/26/16 at 5:00 PM, at the time of the observation. Director of Emergency Services A stated there are no EMTALA signs in the second waiting area or the 11 lower acuity patient rooms.

Based on record review and interview, Emergency Department staff at this facility failed to contact the receiving hospital and talk to a physician who would accept care for 1 of 20 (#1) patients who presented to the emergency department seeking medical treatment. This deficient practice has the potential to affect all patients seeking emergency medical treatment at this facility.

Findings include:

On 9/26/16 at 11:10 AM, reviewed facility policy titled " EMTALA: Patient Transfer to Another Acute Care Facility" dated 12/1/2015. Policy states under procedure, "The hospital receives permission from the receiving facility to transfer the patient to them". The policy also states "Contact the receiving facility. Once a decision to transfer has been made based on the applicable transfer criteria, the physician or qualified medical person shall convey the following information, immediately prior to the transfer, to the facility emergency department or unit to which the patient is being transferred via telephone." "The physician or qualified medical person shall ask the receiving facility contact person if they agree to accept the patient. If yes, the physician or qualified medical person shall obtain their contact information to provide them with the information."

On 9/26/16 at 10:10 AM, conducted at interview with Director of Emergency Services A. Director of Emergency Services stated "Unfortunately there was some miscommunication with this case". Director of Emergency Services A stated "the staff in the emergency department did not contact Children's Hospital prior to transfer [of pt. #1]". Director of Emergency Services A stated a "transfer form was completed however is was not completed correctly".

On 9/27/16 at 9:00 AM, conducted an interview with Emergency Department Physician D. Physician D stated, " I guess I made an assumption that since the Flight for Life was activated at the scene and I was giving endorsements to the staff in front of me that I didn't need to call Children's Hospital, I thought they knew he [pt. #1] was coming. It never crossed my mind to call Children's Hospital."

On 9/27/16 at 9:15 AM, conducted interview with Emergency Department Registered Nurse C. Emergency Department Registered Nurse C stated "I did not call Children's Hospital, that is the one thing I could have done and perhaps that would have prevented this miscommunication".

Per review of medical record from Wheaton Franciscan Medical Center on 9/26/16 at 2:40 PM of pt. #1, Emergency Department provider note dated 9/18/16 at 6:21 PM stated, "Pt #1 arrived at All Saints Medical Center via Emergency Medical Services on 9/18/16 at 6:12 PM. The patient is a 7 year old male who presents to the ED (Emergency Department) via EMS (Emergency Medical Services) for a car versus pedestrian". Form titled EMTALA indicates the following information, "Medical condition- patient unstable. Reason for transfer- medically indicated. Medical benefit- obtain a higher level of care. Medical risk- deterioration of condition route. Mode of transportation- Helicopter. Transport Agency- Flight for Life. Support/Treatment during transfer- cardiac monitor, IV (intravenous) pump, IV fluids, oxygen. Diagnosis- peds (pediatric) versus auto, blunt head trauma. Receiving facility- CHOW (Children's Hospital of Wisconsin). Receiving MD- peds transfer team. Transferring MD signature/name- [ED physician D]. Medical records- Copy of pertinent medical records , and copy of transfer sheet". Form states "Emergent transfer- parents verbal consent obtained." Form is signed by Registered Nurse C.

Per review of medical record from Children's Hospital on 9/27/16 at 8:00 AM of pt. #1, no indication of communication with transferring hospital (Wheaton Franciscan All Saints Medical Center).