HospitalInspections.org

I. Based on document review and staff interviews, the hospital's emergency department (ED) staff failed to follow the hospital's policies when the ED staff failed to provide a medical screening examination for 1 of 30 patients reviewed (Patient #30) that presented to the ED and requested care. Failure of the hospital's ED staff to provide a medical screening examination within the hospital's capabilities resulted in the hospital's ED staff's failure to determine whether or not an emergency medical condition existed, which could have resulted in an adverse event or even death. The hospital's administrative staff identified a monthly average of 2,961 patients presented to the ED and requested emergency care per month.

Findings include:

1. Review of the hospital policy "EMTALA," dated 8/2018, revealed in part, "...GRMC [Greater Regional Medical Center] is a hospital with an emergency department and shall provide to any individual, including every infant who is born alive, at any stage of development, who 'comes to the emergency department' an appropriate Medical Screening Examination ('MSE') within the capability of the GRMC's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition ('EMC') exists ..."

2. During an interview on 11/13/19 at 1:00 PM, ED Registered Nurse (RN) B revealed that Patient Service Associate (PSA) A notified her that Patient #30 presented to the ED requesting treatment. However, Patient #30 had a family member accompanying him who was "banned" from the hospital's property. ED RN B stated he instructed PSA A to contact the hospital's security office and the police.

3. During an interview on 11/13/19 at 3:20 PM, PSA A revealed that Patient #30 presented to the ED complaining of a cough and shortness of breath. Patient #30 was accompanied by a family member who was "banned" from the hospital property. PSA A notified ED RN B, and ED RN B instructed PSA A to contact the hospital's security officer and the local police. After the police officer spoke with Patient #30's family member, both Patient #30 and the family member left the hospital. PSA A confirmed that patient #30 did not receive a medical screening examination prior to leaving the hospital.

Please refer A-2406 for additional information.

II. Based on document review and staff interviews, the hospital's administrative staff failed to ensure the ED registration staff followed the hospital's policies and placed 1 of 101 patients on the Great River Medical Center's (GRMC) Emergency Department (ED) log of patients who presented to the hospital's dedicated ED and requested care. Failure to include all patients who requested a medical screening exam on the central log could potentially result in the administrative staff being unable to identify all patient needs for the community. The hospital's administrative staff identified an average of 2,961 patients per month who presented to the hospital's dedicated ED and requested medical care.

Findings include:

1. 1. Review of policy "ED Patient Log," revised 9/2016, revealed in part, "... The ED Log (or Control Registry) is continuously maintained via input of patient registration data into the computer registration process. Patient name, address, age, sex, date, physician, time, and nature of complaint automatically come into the ED Log with the registration process...."

2. Review of policy "Registration Policy and Procedure", revised 10/2017, revealed, in part, "... Emergency Department Registration. The patient presents to the registration desk. The ED Patient Services Associate will receive patient through a quick registration which goes to the ED tracker ... The quick registration will capture name, date of birth, sex, chief complaint, arrival mode, and primary care provider.... The patient is then seen by the triage nurse...."

3. Review of the emergency department's central log for 11/07/2019 revealed 101 patients presented to the dedicated emergency department and requested emergency medical care on that day. The central log did not include information which indicated Patient #30 presented to the dedicated emergency department and requested medical care.

4. During an interview on 11/13/19 at 3:20 PM, Patient Service Associate (PSA) A revealed that Patient #30 presented to the ED on 11/7/19 at approximately 1:00 AM complaining of a cough and shortness of breath. PSA A told Patient #30 to have a seat in the waiting room and PSA A would return shortly. PSA A then notified the ED nursing staff that Patient #30 was accompanied by a family member which the hospital staff had "banned" from the hospital property. The nursing staff instructed PSA A to wait to return to Patient #30 until the hospital's contracted security officer and a police officer arrived in the ED. Following a discussion with police officer, Patient #30 and his family member left the hospital property. PSA A acknowledged they failed to register Patient #30, in accordance with hospital policy, and place Patient #30 on the hospital's ED central log.

Please refer to A-2405 for additional information.

Based on document review and staff interviews, the administrative staff failed to ensure the Emergency Department (ED) registration staff included 1 of 101 patients who presented to Great River Medical Center's (GRMC) ED on 11/7/19 (Patient #30) and requested emergency medical care. Failure to include all patients requesting emergency medical care could potentially result in the hospital's administrative staff failing to identify the needs of all patients in the community the hospital served. The hospital's administrative staff identified an average of 2,961 patients presented to the hospital's dedicated ED and requested emergency medical care.

Findings include:

1. Review of the emergency department's central log for 11/07/2019 revealed 101 patients presented to the dedicated emergency department and requested emergency medical care on that day. The central log did not include information which indicated Patient #30 presented to the dedicated emergency department and requested medical care.

2. During an interview on 11/13/19 at 3:20 PM, Patient Service Associate (PSA) A revealed that Patient #30 presented to the ED on 11/7/19 at approximately 1:00 AM complaining of a cough and shortness of breath. PSA A told Patient #30 to have a seat in the waiting room and PSA A would return shortly. PSA A then notified the ED nursing staff that Patient #30 was accompanied by a family member which the hospital staff had "banned" from the hospital property. PSA A stated that ED Registered Nurse (RN) B instructed her to wait to return to Patient #30 in the waiting room until the hospital's security officer and a police officer arrived in the ED. Following a discussion with the security officer and police officer, Patient #30 and his family member left the hospital property. PSA A acknowledged they failed to register Patient #30, in accordance with hospital policy, and place Patient #30 on the hospital's ED central log.

3. During an interview on 11/14/2019 at 4:00 PM, the Emergency Department Director acknowledged Patient #30 did not appear on GRMC's emergency department log. The Emergency Department Director acknowledged the ED staff should have placed Patient #30 on the ED's central log [indicating patient # 30 was seeking assistance, and whether he refused treatment or was refused treatment, or whether he was treated, stabilized, transferred or discharged].

Based on document review and staff interviews, the hospital's administrative staff failed to ensure the Emergency Department (ED) staff provided 1 of 30 patients, selected for review (Patient #30), a medical screening examination within the hospital's capabilities. Failure to provide a medical screening examination resulted in the ED staff failing to identify a potentially life threatening condition, and the patient suffering avoidable pain, disability, or death. The hospital administrative staff identified an average of 2,961 patients per month who presented to the hospital's dedicated ED and requested emergency medical care.

Findings include:

1. During an interview on 11/13/19 at 3:20 PM, Patient Service Associate (PSA) A revealed that Patient #30 presented to the ED complaining of a cough and shortness of breath. PSA A told Patient #30 to have a seat in the waiting room and PSA A would return shortly. PSA A then notified the ED nursing staff that Patient #30 was accompanied by a family member which the hospital staff had "banned" from the hospital property. PSA A stated that ED Registered Nurse (RN) B instructed her not to return to Patient #30 in the waiting room until the hospital's security officer and a police officer arrived in the ED. Following a discussion with the security officer and police officer, Patient #30 and his family member left the hospital property.

2. During an interview on 11/13/19 at 1:00 PM, ED RN B revealed that PSA A informed him that Patient #30 had presented to the hospital's ED accompanied by a family member which the hospital had "banned" from the hospital's premises. PSA A told RN B that she was not comfortable bringing Patient #30's family member back to the ED. ED RN B instructed PSA A to contact the hospital's security officer and the local police department. ED RN B stated that "banned patients can come into the ED but they have to have an escort."

3. During an interview on 11/13/19 at 3:00 PM, Security Officer (SO) C revealed they responded to the hospital's ED at the request of the ED staff. SO C waited for the police officer to show up and escorted the police officer to Patient #30's family member. The police officer spoke to Patient #30's family member, then Patient #30 and his family member left the hospital.

4. During an interview on 11/14/2019 at 4:00 PM, the Emergency Department (ED) Director acknowledged that ED staff did not provide Patient # 30 with a medical screening examination.

5. During an interview on 11/14/19 at 1:20 PM, Patient #30's family member revealed they accompanied Patient #30 to the ED on 11/7/19 at approximately 1:00 AM because Patient #30 was complaining of chest pain. After Patient #30 provided their name, the ED staff summoned the police. After the police arrived, the police asked the family member to leave. The family member stated that the ED staff did not come out and talk with patient # 30. The family member stated that he he has power of attorney for patient # 30, that he was complaining of chest pain, so he took him to another hospital for an examination.

6. Review of Hospital B's medical record showed that Patient # 30, an 84 year old presented to the ED with his family member on 11/7/19 at approximately 2:00 AM. Further documentation showed that ED staff provided patient # 30 with a medical screening examination and treatment.