HospitalInspections.org

Based on review of hospital policies and procedures, hospital documents, medical records, and staff interviews, it was determined that the Hospital delayed examination and treatment for one (1) patient (Patient #1) that presented to the Emergency Department via Emergency Medical Services EMS transport.


Findings Include:

Patient #1 presented to Banner Baywood Medical Center Emergency Department (ED) on 09/12/2022 at 1509 via Emergency Medical Services (EMS) ambulance from Patient #1's home due to lethargy and a recent fall. EMS waited with Patient #1 in the ED corridor for a room to become available for approximately one hour and 55 seconds. EMS transferred care to the hospital at approximately 1620 for triage. Patient #1 was given an ESI of 2 and was seen by the medical provider at 1621. Patient #1 was discharge on 09/13/2022 at 1843 to a skilled nursing facility.

Hospital policy titled "Department Patient Care " revealed: "...Triage assessment: Completed by a RN and/or QMP (qualified medical professional). If a paramedic is used to expedite triage to assist with high volume, the RN oversees the ESI scoring, care plan of the patient and utilizes standing orders when needed. An Emergency Severity Index (ESI) score is assigned when the triage assessment is completed. ESI 1= Requires immediate life-saving interventions ...ESI 2= High risk situation or confused, lethargic, disoriented or severe pain distress...ESI 3= two or more resources may be needed ...ESI 4=One or more resource may be needed...ESI 5+ No resources needed ...ED triage documentation may include, but is not limited to: 1. Chief complaint, vital signs, paint ad oxygenation. 2. Mode of arrival and mechanism of injury. 3. Triage assessment and ESI scoring. 4. Infectious disease screening. 5. Suicide screening...Medical Screening Exam: A medical screening exam (MSE) is completed by an Emergency Physician or QMP...When applicable the ED medical provider and/or QMP will complete the MSE in conjunction with an RN or Paramedic as a joint assessment...General Nursing Care: Patients arriving from all portals of entry into the ED will receive a baseline assessment of their chief complaint by a registered nurse, physician or designee...."

Hospital policy titled "EMTALA-Medical Screening Examination and Stabilization Treatment" revealed: "...When an EMS provider brings an individual to the Hospital with a Dedicated Emergency Department and the Hospital does not have the capacity or capability to provide an immediate medical screening exam and if needed, stabilizing or an appropriate transfer, the Hospital must still assess the individual upon arrival to ensure that the individual is appropriately prioritized based on presenting signs and symptoms. Hospital should assess whether the EMS can appropriately monitor the individual ' s condition...."

Hospital document titled, "Plan of Correction" dated 12/12/2022, revealed: " ...staff were re-educated during staff huddles, staff meetings and at charge nurse meetings on the expectation that patients will be triaged upon arrival to the Emergency Department regardless of mode of arrival and assessed according to the assigned Emergency Severity Index (ESI) level ...A new workflow was developed where EMS "quick look/triage" is done upon arrival for patients arriving by EMS ...starting on 08/22/2022, with education occurring through 11/17/2022 ...."

Review of the EMS Triage Process revealed: " ...No Open Room ...CN, Float RN, or Medic triage patients. EMS patient stays in the back hallway until a room becomes available ...."

Emergency Medical Services (EMS) medical record revealed that Patient #1 was taken by ambulance to Banner Baywood ED on 09/12/2022 arrival at 1509, registration at 1620. The EMS narrative revealed " ...patient presented very lethargic and was found to be hypotensive. IV access was established and fluids were administered. Patient's family requested that the Patient be transported to [Banner Desert] because the patient had brain surgery there on 08/15/2020. A courtesy notification was given to [Banner Desert] but they refused due to their facility being on Neuro divert. A courtesy notification was given to Banner Baywood and they accepted the patient. Medic 262 arrived at Banner Baywood at 1509. Charge nurse approached us at 1530 and advised us that she was working on where we were going to go, but no ETA was provided. Per procedure [Chief Williamson] was advised in the Group Me chat at 1540 that we had been at the facility for 30 minutes. [Chief Williamson] asked us to keep [him] posted on our wait time. [Chief Williamson] was advised at 1556 via a phone call that we had not yet received a bed assignment. [Chief Williamson] advised us that [he] had contacted the house supervisor at 1559. [Chief Williamson] was advised at 1614 via the Group Me chat that we had reached the one-hour mark and still had not received a bed assignment. We were given a room assignment a few minutes, unsure of the time. Report was given to the receiving nurse and patient was transferred at 16:20:55 ...."

Review of Patient #1 medical record dated 09/12/2022 revealed Patient #1 was triaged at 1620 and assigned an ESI level of 2. Further review of the medical record revealed a medical screening examination was performed at 1621. Further review of the medical record revealed Patient #1 was discharged on 09/13/2022 at 1843 to a skilled nursing facility.

Further review of Patient #1 medical record revealed no evidence of documentation of nursing staff or medical providers assessing the patient prior to triage and the medical screening examination.

Review of Patient #1 PreHospital Care Report from EMS dated 09/12/2022 revealed no evidence of documentation of EMS assessing or monitoring patient before triage.

Nineteen (19) additional ED patient records were randomly selected from the ED Central Logs were reviewed. There was no documentation that there were any delays in medical screening examinations or treatments based on patient ability to pay for medical services.


Employee #27 confirmed during an interview conducted on 04/03/2023 that if a patient waits more than 20 minutes for triage EMS or a RN will monitor the patient until a room is available. EMS will document the monitoring in there EMR system. The RN will document the monitoring in the hospital EMR system. The EMS company will fax or email the documentation with the monitoring. Employee #27 confirmed that once the documentation is received that they will scan the documents into the Prehospital Folder in the patients Medical Record.

Employee #9 confirmed during an interview conducted on 03/29/2023 patients are to be triaged upon arrival to the ED. Employee #9 confirmed that the patient is triaged and an MSE is done once the patient is roomed. Employee #9 confirmed on 03/29/2023 that if the provider can not perform an MSE upon arrival, the provider will do a quick assessment of the patient, however, most providers do not document this assessment in the medical record.

Employee #9 confirmed during an interview conducted on 04/03/2023 verified that if a patient waits for a triage EMS or a RN will monitor the patient until a room is available. Documentation of that monitoring is scanned into the Prehospital Folder. Employee #9 stated that a time of vitals and monitoring can also be viewed on the ED timeline tab in the facilities EMR. Employee #9 confirmed during Patient #1 medical record review that vitals or monitoring was not documented for Patient #1 from the time EMS arrived to the hospital at 1509 until the patient was triaged at 1620. Employee #9 confirmed on 04/03/2023 that Patient #1 was not triaged or had an MSE done on arrival.