HospitalInspections.org

Based on medical record reviews and staff interviews it was revealed the facility failed to ensure staff provided an appropriate medical screening (see tag A 2406), failed to provide stabilizing treatment (see tag A 2407), failed to obtain proper consent for treatment (see tag A 2408) and failed to provide appropriate transfer (see tag A 2409).

Based on medical record reviews, staff interviews and document review it was revealed the facility failed to ensure the on call physicians responded to emergencies in the Emergency Department (ED) when notified by the ED physician. This failure was identified in one (1) of two (2) patients transferred to another facility (patient #1). This failure has the potential to adversely affect all patients.

Findings include:

1. A review of the medical record for patient #1 revealed patient #1 was brought to the ED by emergency medical services (EMS) on 6/11/20 at 5:28 a.m. due to being hit by a semi-truck. Patient #1 was diagnosed with a pneumonthorax and displaced shaft fracture. The trauma surgeon was called at 5:08 a.m. and arrived at 6:34 a.m. The orthopedic specialist was called at 5:53 a.m. and arrived at 8:04 a.m.

2. A telephone interview was conducted with the Director of the ED on 7/7/20 at 10:30 a.m. When asked about his expectations for on call physicians he stated, "When they are called, they are to come to the ED." When asked about documentation concerning the notification of the on call physicians by the ED physician, he stated it would be located on the trauma sheet.

3. A review of the medical staff rules and regulation approved by the governing body on 8/7/19 stated in part: "Failure of any on-call physician to respond to an emergency and/or to assist when requested for further evaluation/treatment of a patient within thirty (30) minutes of being notified may be in violation of EMTALA regulations."

4. A review of the policy titled "EMTALA ON CALL COVERAGE, REVIEWED 10/14/08" stated in part: "Arrival or response to the dedicated emergency department should be within a reasonable timeframe. Generally, response is expected within thirty (30) minutes."

Based on document reviews and staff interviews it was revealed one (1) patient was not registered on the Emergency Department (ED) log after arriving on 6/27/20. This failure has the potential to adversely affect all patients.

Findings include:

1. Staff interviews revealed a patient arrived at the ED on 6/27/20 by Emergency Medical Services (EMS). A review of the ED log revealed the patient was not registered in the ED.

2. An interview was conducted with the Chief Executive Officer on 7/6/20 at 11:04 a.m. He concurred the patient was not registered when she arrived at the ED.

3. An interview was conducted with the Clinical Nurse Manager on 7/7/20 at 10:54 a.m. She stated she tried to get the physician to registered the patient and provide a medical screening but he talked to the patient and had the ambulance to transport her to another facility. She concurred the patient was not registered.

4. A telephone interview was conducted on 7/7/20 at 7:23 p.m. with the ED physician. He stated when the patient arrived at the ED he informed the patient they did not provide obstetrical services. He stated he talked to the patient and she wanted to go to another facility. He concurred the patient was not registered and did not get a medical screening.

5. A review of the policy titled "EMTALA- Central Log, ADOPTED: 08/2005" stated in part: "It is the policy of Appalachian Regional Healthcare, Inc. (ARH) that each ARH facility providing emergency services must maintain a central log to include information on each individual who comes to the dedicated emergency department seeking examination,etc..."

Based on staff interviews and document review it was revealed one (1) patient did not receive a medical screening examination after arriving at the Emergency Department (ED). This failure has the potential to adversely affect all patients.

Findings include:

1. Staff interviews revealed a patient arrived at the ED on 6/27/20 by Emergency Medical Services (EMS). A review of the ED log revealed the patient was not registered to the ED.

2. An interview was conducted with the Clinical Nurse Manager on 7/7/20 at 10:54 a.m. She stated she tried to get the physician to register the patient and provide a medical screening exam but he talked to the patient and had EMS transport her to another facility. She concurred no medical screening was provided.

3. An interview was conducted on 7/7/20 at 7:23 p.m. with the ED physician. He stated when the patient arrived at the ED he informed the patient they did not provide obstetrical services. He stated he talked to the patient and she wanted to go to another facility. He concurred the patient was not registered and did not get a medical screening.

4. A review of the policy titled "EMTALA- Medical Screening, ADOPTED: 8/2005" stated in part: "PURPOSE: To ensure that all patients requesting emergency services in an area of any facility owned by ARH, Inc., meeting the definition of a dedicated emergency department, receive an appropriate Medical Screening Examination... Medical Screening Examination (MSE) is the process required to reach, with reasonable clinical confidence, the point at which it can be determined whether or not an emergency medical condition exists or a woman is in labor."

Based on staff interviews and document reviews it was revealed one (1) patient did not receive stabilizing treatment after arriving at the Emergency Department (ED) on 6/27/20 and before being transferred to another facility. This failure has the potential to adversely affect all patients.

Findings include:

1. Staff interviews revealed a patient arrived at the ED on 6/27/20 by Emergency Medical Services (EMS). The patient was not registered to the ED, did not receive a medical screening exam and she did not receive stabilizing treatment before being transferred to another facility.

2. An interview was conducted with the Clinical Nurse Manager on 7/7/20 at 10:54 a.m. She stated she tried to get the physician to register the patient and provide a medical screening exam but he talked to the patient and had EMS transport her to another facility. She concurred no medical screening was provided.

3. An interview was conducted on 7/7/20 at 7:23 p.m. with the ED physician. He stated when the patient arrived at the ED he informed the patient they did not provide obstetrical services. He stated he talked to the patient and she wanted to go to another facility. He concurred the patient was not registered and did not get a medical screening.

4. A review of the policy titled: "EMTALA-STABILIZATION, REVIEWED 10/14/08" stated in part: "To stabilize or be stabilized means, with respect to an emergency medical condition, the individual is provided such medical treatment as is necessary to assure, within reasonable medical probability, that no material deterioration the condition is likely to result from, or occur during, the transfer of the individual from the facility:..."

Based on medical record reviews, document review and staff interviews it was revealed the facility failed to follow reasonable registration process for obtaining consent to treat before being seen by a provider. This failure was identified in twenty (20) of twenty-four (24) medical records reviewed (patient #2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and 21). This failure has the potential to adversely affect all patients.

Findings include:

1. A review of the medical record for patient #2 revealed patient #2 was seen by the provider at 1:32 p.m. on 6/28/20 and the consent to treat was signed at 6:11 p.m. on 6/28/20.

2. A review of the medical record for patient #3 revealed patient #3 was seen by the provider at 10:17 p.m. on 6/2/20 and the consent to treat was signed at 10:40 p.m. on 6/2/20.

3. A review of the medical record for patient #4 revealed patient #4 was seen by the provider at 7:48 p.m. on 6/8/20 and the consent to treat was signed at 11:38 p.m. on 6/8/20.

4. A review of the medical record for patient #5 revealed patient #5 was seen by the provider at 7:39 p.m. on 6/8/20 and the consent to treat was signed at 11:36 p.m. on 6/8/20.

5. A review of the medical record for patient #6 revealed patient #6 was seen by the provider at 2:22 p.m. on 6/12/20 and the consent to treat was signed at 3:28 p.m. on 6/12/20.

6. A review of the medical record for patient #7 revealed patient #7 was seen by the provider at 1:22 p.m. on 6/5/20 and the consent to treat was signed at 2:25 p.m. on 6/5/20.

7. A review of the medical record for patient #8 revealed patient #8 was seen by the provider at 8:15 p.m. on 6/3/20 and the consent to treat was signed at 9:06 p.m. on 6/3/20.

8. A review of the medical record for patient #9 revealed patient #9 was seen by the provider at 3:39 a.m. on 6/3/20 and the consent to treat was signed at 4:54 p.m. on 6/3/20.

9. A review of the medical record for patient #10 revealed patient #10 was seen by the provider at 4:46 p.m. on 5/4/20 and the consent to treat was signed at 6:06 p.m. on 5/4/20.

10. A review of the medical record for patient #11 revealed patient #11 was seen by the provider at 1:17 p.m. on 5/4/20 and the consent to treat was signed at 1:36 p.m. on 5/4/20.

11. A review of the medical record for patient #12 revealed patient #12 was seen by the provider at 12:28 p.m. on 5/2/20 and the consent to treat was signed at 1:24 p.m. on 5/2/20.

12. A review of the medical record for patient #13 revealed patient #13 was seen by the provider at 6:45 p.m. on 5/16/20 and the consent to treat was signed at 8:46 p.m. on 5/16/20.

13. A review of the medical record for patient #14 revealed patient #14 was seen by the provider at 1:14 p.m. on 6/22/20 and the consent to treat was signed at 4:33 p.m. on 6/22/20.

14. A review of the medical record for patient #15 revealed patient #15 was seen by the provider at 6:48 a.m. on 5/25/20 and the consent to treat was signed at 1:10 p.m. on 5/25/20.

15. A review of the medical record for patient #16 revealed patient #16 was seen by the provider at 9:34 p.m. on 6/1/20 and the consent to treat was signed at 10:02 p.m. on 6/1/20.

16. A review of the medical record for patient #17 revealed patient #17 was seen by the provider at 9:24 p.m. on 5/18/20 and the consent to treat was signed at 9:42 p.m. on 5/18/20.

17. A review of the medical record for patient #18 revealed patient #18 was seen by the provider at 2:39 p.m. on 6/1/20 and the consent to treat was signed at 3:32 p.m. on 6/1/20.

18. A review of the medical record for patient #19 revealed patient #19 was seen by the provider at 7:13 p.m. on 6/1/20 and the consent to treat was signed at 8:45 p.m. on 6/1/20.

19. A review of the medical record for patient #2 revealed patient #2 was seen by the provider at 1:32 p.m. on 6/28/20 and the consent to treat was signed at 6:11 p.m. on 6/28/20.

20. A review of the medical record for patient #20 revealed patient #20 was seen by the provider at 9:10 p.m. on 5/11/20 and the consent to treat was signed at 9:58 p.m. on 5/11/20.

21. A review of the medical record for patient #21 revealed patient #21 was seen by the provider at 11:48 a.m. on 6/11/20 and the consent to treat was signed at 2:34 p.m. on 6/211/20.

22. A review of the policy titled "Consent for Treatment in the Emergency Department APPROVED: 10/1/02" stated in part: "The Admission/Nursing personnel will have the patient sign the Consent for Treatment forms part of the screening process in preparation for examination by the physician/mid-level provider."

23. A telephone interview was conducted with the Director of Program Improvement on 7/7/20 at approximately 1:00 p.m. She concurred a consent for treatment must be signed before the patient is seen by a provider.

Based on document review and staff interviews an inappropriate transfer of a patient to another facility was revealed. This failure has the potential to adversely affect all patients

Findings include:

1. Staff interviews revealed a patient arrived at the ED on 6/27/20 by Emergency Medical Services (EMS). The patient was not registered to the Emergency Department (ED) and she did not receive a medical screening.

2. An interview was conducted with the Clinical Nurse Manager on 7/7/20 at 10:54 a.m. She stated she tried to get the physician to register the patient and provide a medical screening but he talked to the patient and had EMS to transport her to another facility.

3. An interview was conducted on 7/7/20 at 7:23 p.m. with the ED physician. He stated when the patient arrived at the ED he informed the patient they did not provide obstetrical services. He stated he talked to the patient and she wanted to go to another facility. He concurred the patient was not registered and did not get a medical screening.

4. A review of the policy titled: "Transfer of Patient" stated in part: "ARH has established and implemented a policy regarding justification for transferring of patients when the provider determines definitive care cannot be provided to the patient. Transfers will be made only at the request of the patient or his family or when adequate treatment cannot be carried out at the clinic."