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Based on policy and procedure review, medical record review, and interview, it was determined the facility failed to provide a Medical Screening Exam (MSE) for 1 (#1) of 25 (#1-#25) patient presenting to the facility's dedicated emergency department and failed to follow the facility's established policy for workplace violence for one of one (#1) patient seen in the Emergency Department. The failed practice had the likelihood to affect any patient presenting to the Emergency Department and all Emergency Department staff. Findings follow:

A. Review of policy and procedure titled, "CHI St. Vincent Policies and Procedures for the Examination, Treatment and Transfer of Individuals Who 'Come to the emergency department'" revised 2019, showed that "The hospital will provide any individual, including any infant who is Born Alive at any stage of development, who 'Comes to the Emergency Department' an appropriate Medical Screening Examination (MSE) within the capabilities of the Hospital's Dedicated Emergency Department (DED), including ancillary services routinely available to the DED, to determine whether or not an Emergent Medical Condition (EMC) exists, regardless of the individual's ability to pay. The MSE will be conducted by an individual(s) determined qualified by the Hospital bylaws or rules and regulations."

B. Review of the facility's policy titled, "Workplace Violence Prevention - CHI ST. Vencent Infirmary," showed, "Acts or threats of physical violence, including but not limited to, coercion, intimidation, harassment, or destruction of property that involves or affect patients, visitors, vendors, staff, volunteers, physicians and contract employees of SVHS will not be tolerated. Incidents of assault or battery: Call security or designee of the incident and involve them in the initial securing of the area. If Security or designee is not available on site, call 911. At the earliest opportunity thereafter, notify the identified site security leader of the incident. An IRIS report (incident report) should be completed in addition to the standard security report. Post Incident Actions: Immediately, create an IRIS report."

C. Review of Patient 1's ED (Emergency Department) Event Note dated 11/06/2023 showed the following:
1) 9:50 PM: ED Event Location: Lobby. ED Description of Event: Patient was brought in by (Named Ambulance Service), paramedic reported patient was picked up at a church, but he had walked around to an alley. The patient was in a Motor Vehicle Accident (MVA) on Saturday and was having pain in his left (L) leg and arm but there were no obvious deformities or bleeding. (Named Ambulance Service) took the patient to triage/waiting room area and was placed in a wheelchair, paramedic then rolled patient over to a waiting room chair and propped L foot on the chair.
2) 9:55 PM: Security approached patient and asked patient to remove foot from the chair. Patient reported the worker put it there and yelled at the security officer. (Named nurse) triage nurse went out of waiting area and saw patient with his L foot on top of chair and right (R) foot underneath holding chair by the cushion. (Named nurse) then instructed patient he was not to have feet propped in chairs due to (d/t) sanitary reasons. The patient began to yell louder, and security assist was called to Emergency Room (ER) lobby.
3) 10:00 PM: This nurse presented to lobby and witnessed patient with feet holding chair by the cushion and lying on side in the wheelchair. The named nurse informed me of the situation and this nurse approached the patient. I asked patient to sit properly in the wheelchair, patient refused, then I asked patient to remove his foot from the waiting room chair and he refused. This nurse informed patient that we did not allow patients to lie in chairs or prop feet up in them, patient stated "well the girl put it there" and I replied "I understand that but she does not work for us and we will have to roll you in the wheelchair and cannot roll you if you are laying like this in it," patient yelled "I don't care, they put me like this and I'm hurting, put me back on that (expletive) bed then." Patient was told that the ambulance that brought him was unavailable and could not do that. I stated, "I'm sorry but you will have to sit up in this wheelchair properly." Pt continued to refuse. This nurse then stated "Sir, all we are asking is for you to cooperate, so either you can or we can call the police and you can leave," Patient yelled "Call the police." The security present then made call to call (Named Local Police Department). This nurse walked away and watched in the waiting room near triage door as patient laid in the wheelchair with 4 security guards around him. One security guard continued to ask the patient to just cooperate, patient then used his right arm and R hand balled in a fist and swung in at the security guard's face, patient was then picked up out of the wheelchair and taken outside by security."

D. During an interview on 02/12/2024 at 2:45 PM, Clinical Director confirmed the findings in B.

E. During an interview on 02/12/2024 at 2:45 PM, when this surveyor asked Clinical Director if the patient received a MSE the Clinical Director replied. "It doesn't look like he did because he became violent."

F. A request was made to the Director of Regulatory Compliance for the IRIS or Security report related to Patient #1.

G. Email received on 3/20/2024 at 3:57 PM provided by Director of Regulatory Compliance, confirmed there was no IRIS or Security report completed for Patient #1.

Based on review of policy and procedure, clinical records and interview, it was determined the facility failed to conduct an appropriate transfer for two (#2 and #3) of five (#2-#6) patients transferred from the emergency department to other facilities emergency departments in that the facility failed to complete the "Patient Transfer Summary Form" which identified the risks and benefits of the transfer to the patient/patient's representative and the notification and acceptance of the receiving facility. The failed practice did not ensure the patient/patient's representative was informed of the risks and benefits of the transfer and failed to ensure the accepting facility had the capacity and capability to treat the patient. The failed practice had to likelihood to affect all patients transferred out of the facility. The findings follow:

A. Review of policy and procedure titled, "Model Policies and Procedures for the Examination, Treatment and Transfer of Individuals in Need of Emergency Medical Services," showed that exhibit B Patient Transfer Summary Form should be completed prior to transfer of individuals.

B. Review of Patient #2's clinical record showed Patient #2 was admitted to the dedicated emergency room via ambulance for a gunshot wound (GSW) and multiple injuries related to a third-floor fall. Patient #2 required a higher level of care for open fracture and arterial involvement. Documentation showed that Patient #2 was transferred to another facility. There was no evidence the Patient Transfer Summary Form was completed.

C. The findings in A and B were confirmed with the Clinical Director on 02/12/2024 at 2:45 PM.

D. Review of patient #3's clinical record showed that patient #3 was admitted to the dedicated emergency department with a diagnosis of pneumonia. Patient #3 required a higher level of care at a dedicated pediatric facility. Patient #3 was transferred to another facility via ambulance. There was no evidence the Patient Transfer Summary Form was completed.

E. The findings in A and C were confirmed with the Clinical Director on 02/12/2024 at 2:45 PM.