HospitalInspections.org

Based on staff interviews and hospital policy and procedure reveiw the hospital failed to follow their policy and failed to provide a medical screening examination to a patient that presented to the hospital emergency department for one of 20 sampled records (#1).

Findings include:

- Review on 12/14/10 at 7:00pm of the hospital's policy titled "Transfer of Patients In and Out of the ED (Emergency Department) from Outside Facilities" directed "...Every patient (regardless of condition, race, religion, or ability to pay) presenting to the ED will be provided with an appropriate medical screening examination within our capabilities, to determine whether the patient has an emergency medical condition and to conclude a reasonable diagnosis. This exam will be conducted by the Emergency Department physician on duty. Stabilization and all necessary definitive treatment will be provided. Treatment will ensue prior to any necessary transfer..."

- Review of patient #1's emergency room record on 12/13/10 at 4:10pm revealed an encounter information sheet indicating the patient presented to the emergency department (ED) at Kansas Medical Center on 10/30/10 at 1505 (3:05pm) with an admit reason of a medical problem. Patient #1's ED record contained a registration to the ED, a patient information sheet, identification and insurance information, and a signed authorization agreement. The ED record contained a Physician progress note dated 10/30/10 at 1710 (5:10pm) documented " ...the E. R. was very busy when this patient showed up and said he had " his liver drained " the day before and was "supposed to have surgery here on Monday." Staff H thought maybe he'd be good candidate for direct admit. Staff G (an on call physician) working for staff F (a physician) - said he didn't come out here. I called staff F just to get the story. Staff F did return call - said since he wasn't on - staff G didn't come out here send him to hospital Z. The pt was walking around outside had been dry heaving - had abdominal pain but at the moment said he was feeling OK. Told him about the calls - his sister said she'd take him to hospital Z. They were not upset and understood the reasoning. I did call and tell staff G and ED doctor (at hospital Z) what staff F had told me ... " Staff E (the ED physician on duty 10/30/10) signed the note. The computerized medical record contained a screen noting patient #1's admission to the ED on 10/30/10 at 1505(3:05pm) and discharged at 1710 (5:10pm). The record failed to include a medical screening exam including vital signs to determine if an emergency medical condition existed.

- Review of the ED medical record at revealed patient #1 presented to the ED at hospital Z by private car on 10/30/10 at 4:58pm, one hour and 53 minutes after presenting to Kansas Medical Center for emergency care.

Administrative staff B and C from Kansas Medical Center interview on 12/13/10 at 1:25pm acknowledged patient #1 presented to the ED and directed to go to hospital Z prior to receiving a medical screening examination. Staff D on Monday 11/1/10 reported, a patient that presented to the ED failed to receive a medical screening examination (MSE).

Based on document review and interview the hospital failed to have written policies and procedures to follow when an on call physician is not available to respond to the emergency department.

Findings include:

- On 12/13/10 at 1:25pm information was requested that included the hospital's policy and procedure for on call physicians in the emergency department.

Staff D interviewed on 12/14/10 at 12:40pm acknowledged the hospital lacked a policy for on call physicians.

- Review of the hospital's Medical Staff Rules and Regulations on 12/14/10 at 9:50am revealed the hospital failed to include the duties of an on call physician.

Administrative staff B interveiwed on 12/14/10 at 9:50am reviewed the Medical Staff Rules and Regulations and acknowledged the hospital failed to include the duties of the on call physicians.

Based on document review and interview the hospital failed to maintain a complete emergency room log to track care provide to individuals who come to the hospital seeking care.

Findings include:

- Review of the hospital's emergency department (ED) central log (a log to track each individual who comes to the emergency department seeking care) revealed the hospital failed to record patient #1's encounter at the ED on 10/30/10. The ED log failed to include whether the patient received treatment, stabilized, transferred, or discharged.

- Review of patient #1's emergency room record on 12/13/10 at 4:10pm revealed an encounter information sheet indicating the patient presented to the emergency department (ED) at Kansas Medical Center on 10/30/10 at 3:05pm with an admit reason of a medical problem. Patient #1's ED record contained a registration to the ED, a patient information sheet, identification and insurance information, a signed the authorization agreement, and a Physician progress note. The record failed to include a medical screening exam to determine if an emergency medical condition existed.

Administrative staff C interveiwed on 12/13/10 at 4:10pm reviewed the ED log and
acknowledged the hospital failed to include patient #1 in the ED log and all patients that present to the ED whether they are seen or not are to be in the log.

Based on document review and interview the hospital failed to provide a medical screening exam to determine whether an emergency medical condition existed for one of twenty sampled emergency department patients (patient #1).

Findings include:

- Review of patient #1's emergency room record on 12/13/10 at 4:10pm revealed an encounter information sheet indicating the patient presented to the emergency department (ED) at Kansas Medical Center on 10/30/10 at 1505 (3:05pm) with an admit reason of a medical problem. Patient #1's ED record contained a registration to the ED, a patient information sheet, identification and insurance information, and a signed authorization agreement. The ED record contained a Physician progress note dated 10/30/10 at 1710 (5:10pm) that noted " ...the E. R. was very busy when this patient showed up and said he had " his liver drained " the day before and was "supposed to have surgery here on Monday." The ED nurse thought maybe he'd be good candidate for direct admit. Staff G (an on call physician) working for staff F (a physician) - said he didn't come out here. I called staff F just to get the story. He did return call - said since he wasn't on - staff G didn't come out here send him to hospital Z. The pt was walking around outside had been dry heaving - had abdominal pain but at the moment said he was feeling OK. Told him about the calls - his sister said she'd take him to hospital Z. They were not upset and understood the reasoning. I did call and tell staff G and ED doctor (at hospital Z) what staff F had told me ... " Staff E (the ED physician on duty 10/30/10) signed the note. The computerized medical record contained a screen noting patient #1's admission to the ED on 10/30/10 at 1505(3:05pm) and discharged at 1710 (5:10pm). The record failed to include a medical screening exam including vital signs to determine if an emergency medical condition existed.

- Review of the ED medical record at hospital Z revealed patient #1 presented to the ED at hospital Z by private car on 10/30/10 at 4:58pm, one hour and 53 minutes after presenting to Kansas Medical Center for emergency care.

Administrative staff B and C at Kansas Medical Center interviewed on 12/13/10 at 1:25pm acknowledged patient #1 presented to the ED and directed to go to hospital Z prior to receiving a medical screening examination. Administrative staff C revealed, Staff D (ED Manager), on Monday 11/1/10 reported, a patient that presented to the ED failed to receive a medical screening examination (MSE).

- Review on 12/14/10 at 7:00pm of the hospital's policy titled "Transfer of Patients In and Out of the ED (Emergency Department) from Outside Facilities: directed "...Every patient (regardless of condition, race, religion, or ability to pay) presenting to the ED will be provided with an appropriate medical screening examination within our capabilities, to determine whether the patient has an emergency medical condition and to conclude a reasonable diagnosis. This exam will be conducted by the Emergency Department physician on duty. Stabilization and all necessary definitive treatment will be provided. Treatment will ensue prior to any necessary transfer..."

Kansas Medical Center failed to provide patient #1 with a medical screening examination to determine if a medical emergency existed.