HospitalInspections.org

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Based on medical record review, document review, and interview, in 3 of 13 medical records review, the facility failed to provide emergency care in accordance with acceptable standards of practice. Specifically, the facility did not ensure that patients presenting with chest pains are immediately triaged and its electrocardiogram (ECG) policy was implemented for timely diagnosis and treatment of patients (Patient #s 1, 2 and 3).

Findings include:

Review of medical record for Patient #1 identified a 42-year-old male patient who presented to the Emergency Department (ED) on 01/15/21 at 11:35 am and was 'pre-registered' immediately upon arrival. The patient's chief complaint was chest pain.

At 11:40 am, the patient was called by the ED technician for vital signs assessment; the patient's wife who accompanied the patient to the ED reported he was in the bathroom.

At 11:52 am, the patient was found with agonal breathing (gasping for air) and was resuscitated and intubated after his wife alerted staff that the patient was unresponsive in the bathroom. At 12:24 pm, the patient was taken to the Cardiac Catheterization Lab for cardiac intervention. At 2:10 pm, the patient was pronounced dead.

During interview with Staff E, Registration Clerk on 8/17/2021 at 10:00 am, she stated that pre-registration involves documentation of the patient's name and the chief complaint. The information becomes immediately available in the computer to the triage nurse who uses the information to call patients for triage assessment. If a patient complaint is chest pain, the patient is directed to seat in a chair in the waiting room and the nurse is immediately informed.

During interview with Staff F, Triage Nurse on 8/17/2021 at 10:15 am, she reported she was working as a triage nurse on day of the incident on 1/15/21, the ED Technician called the patient to take the patient's vital signs, but patient's wife responded that he was in the restroom. Staff reported that the patient had not been triaged before he was found unresponsive in the bathroom.

Review of the "ECG Screening Protocol" (Revised 03/2019) revealed the following: "... To ensure that an initial screening ECG is performed on all patients with potential acute coronary syndromes... A 12-lead ECG should be performed and shown to an emergency physician within 10 minutes of emergency department arrival for all patients with chest discomfort or anginal equivalent or other symptoms suggestive of STEMI (A serious type of heart attack) and in patients who have a history of chest discomfort consistent with acute coronary syndrome but whose discomfort has resolved by the time of evaluation..."

There was no documented evidence that the patient was triaged upon arrival to the ED and that staff implemented the facility's ECG Screening Protocol.

Similar findings were identified for Patients #3 and #4 who presented in the ED for complaints of chest pain.

Patient #3, a 69-year-old, presented on 02/03/2021 at 07:48 pm with complaints of chest pain. At 08:10 pm, the patient was triaged and assigned an Emergency Severity Index (ESI) level of two (2). The ECG was performed at 08:24 pm, 22 minutes after the patient arrived in the ED. On 02/04/2021 at 12 am, chest x-ray and laboratory tests were completed at 12:00 am and 2:35 am respectively. At 06:21 am, it was documented that the patient left the ED.

The ECG screening protocol was not timely implemented. There was no documented evidence that the patient was evaluated by a provider.

During interview on 08/18/2021 at 11:00 am, Staff A (RN, Performance Improvement Specialist) acknowledged findings and stated that the patient was evaluated by a provider who did not document the assessment and care rendered.

Patient #4 is a 66-year-old patient who arrived in the ED on 02/03/2021 at 10:32 pm with a chief complaint of chest pain. The patient was assigned ESI level 3 with a pain level of 10 which was the highest on a pain scale level of one (1) to ten (10). The ECG that was ordered on 02/03/2021 at 11:11 pm was completed on 02/04/2021 at 1:07 pm.

The patient did not have a 12-lead ECG performed and shown to an emergency physician within 10 minutes of the patient's arrival to the ED as per facility's protocol. There was no documented evidence of a physician assessment in the medical record.

On 08/18/2021 at 11:30 am, Staff L (RN, Performance Improvement Specialist) confirmed that the medical record lacked documentation of a physician assessment.

On 08/20/2021, at approximately 04:30 pm, these findings were brought to the attention of facility's administrative personnel during a pre-exit conference.