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Based on interview and record review, the facility failed to provide laboratory and subsequent radiology studies (use of imaging technology to diagnose and treat a disease) in a timely manner.

This deficient practice delayed treatment of the patient's (Patient 1) complaint of abdominal pain. Patient 1 later passed away while being treated for an irregular heart rhythm.

Findings:

During an interview on 8/8/2020, at 2:23 P.M., the facility's Director of Emergency Department (DED) stated that on 5/24/2022 he (DED) was in the emergency room (ED) and saw that it was very busy at that time. DED stated that he (DED) went outside and saw patients outside waiting to receive treatment. DED said that he (DED) moved Patient 1 to bed number 4 in the ED; DED noted that Patient 1 was on a non-rebreather mask (device used to supply high concentration of oxygen to the patient), her (Patient 1) oxygen saturation (level of oxygen circulating in blood cells) was low, and the patient's (Patient 1) heart beat rate had been low. DED asserted that the ED doctor was at the bedside of Patient 1, CPR (lifesaving procedure performed when the heart stops) had been started but Patient 1 then coded (emergency declaration that the patient is experiencing respiratory distress, the patient's heart has stopped, or is facing some other medical emergency) for 30 minutes. The DED stated that Patient 1 had come to the ED with a complaint of abdominal pain and that Patient 1's stomach was very rigid. DED then declared that the patient had an order for a stat (given priority over other tests) order for a computed tomography (CT-medical imaging technique to view clear internal images of the body) of the abdomen but that order depended upon the results of a stat laboratory blood test; he (DED) stated that he (DED) did not know why the CT was delayed. DED stated that Patient 1's acuity level of 3 (severity of condition used to prioritize treatment patient care, 3 meaning patient is stable but needs multiple levels of treatment) and the large number of patients in the ED at that time may have contributed to delay in treatment.

During an interview on 8/5/2022, at 5:00 P.M., the facility's Chief Quality Officer (CQO) stated that local Emergency Medical Services (EMS, provider of medical stabilizing services while transporting to a facility for definitive care) does not allow assessment/treatment while patients are on board EMS equipment, i.e.gurney. When questioned about what should be done if EMS does not allow laboratory or radiology studies while on EMS equipment, CQO stated this event should be reported through the hospital chain of command.

During an interview on 8/8/2022, at 2:45 P.M., the Hematology Manager stated that all orders entered in the ED are stat (given priority over other orders); the person who draws blood from the patient for lab testing calls the attending nurse; once the blood is collected, testing is prioritized and results are expected within approximately 1 hour, depending on the test ordered.

During a review of the EMS Transfer Report, this document indicated that, on 5/24/2022, Patient 1 presented with a complaint of shortness of breath for 1 day due to being out of pain medication. The EMS Transfer Report indicated that Patient had bariatric surgery (done to alter the digestive system to help patients lose weight) where a portion of her (Patient 1) stomach and intestine had been removed. The EMS Transfer Report revealed that Patient 1 was adamant about not being on a gurney; the charge nurse and doctor agreed to place her (Patient 1) in a wheelchair. The EMS Transfer Report further indicated that after about an hour and a half of sitting in the wheelchair, Patient 1 became ALOC (altered level of consciousness, not being awake, alert, able to understand or react normally). The EMS Transfer Report indicated the charge nurse was notified and Patient 1 was placed on a hospital bed. Finally, the EMS Transfer Report document indicated that EMS arrived at the facility at 12:27 P.M. and was on facility equipment by 2:28 P.M.

During a review of the medical Orders for Patient 1, the medical orders document showed that a Comprehensive Metabolic Panel (CMP-a blood test that provides information about a patient's blood sugar levels, the balance of electrolytes [essential minerals vital to many key functions of the body] and fluid as well as the health of the kidneys and liver) was ordered on 5/24/2022, at 12:53 P.M., this blood test (CMP) was drawn at 2:10 P.M. and result released at 3:52 P.M. Further review of the 'Laboratory' results (CMP test) indicated the Glomerular Filtration Rate (GFR- test for identifying possible kidney failure), which is a part of the CMP, resulted at 3:52 P.M. Additional review of Patient 1's test orders showed that the Computerized Tomography (CT-a procedure that uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body) was canceled at 3:35 P.M.

During a review of Patient 1's laboratory result, dated 5/24/22, indicated Patient 1's GFR was 22.4 (low-which may indicate kidney failure; Normal range: 60 or higher).

During and interview on 8/8/2022, at 2:45 P.M., the facility's Hematology Supervisor stated that staff had to wait for the laboratory results (including the GFR) before the CT scan can be done.

During a review of the ED Note-Physician "Final Report" the following re-examination/re-evaluations were noted:

1. On 5/24/2022, at 12:48 P.M., the charge nurse notified the ED physician that Patient 1 was in the EMS vehicle, and Patient 1 was examined by the ED physician at that time.

2. On 5/24/2022, at 1:10 P.M., the charge nurse was notified that Patient 1 was sick and needed the next facility bed.

3. On 5/24/2022, at 1:45 P.M., the charge nurse was notified by the ED Physician that Patient 1 was ill appearing and needs the next available bed.

4. On 5/24/2022, at 2:05 P.M., the family was at the side of Patient 1 who was in a wheelchair; Patient 1 was more unresponsive and cyanotic (bluish discoloration due to deficient amount of oxygen in the blood) to the face.

5. The "Final Report" also showed that a "Code Blue (a medical emergency involving cardiac or respiratory arrest)" was called on 5/24/2022, at 2:26 P.M., and Patient 1 expired at 3:03 P.M. on this same day (5/24/22).

6. The "Final Report" also indicated laboratory results showed Patient 1 had elevated white blood cell counts (indicator of possible infection); Patient 1 had profound bandemia (elevated white cells release from bone, also indicator of infection or inflammation); Patient may have had sepsis (local infection that spreads to other parts of the body) related to recent surgery; Bowel perforation (hole in the lining of the intestine) and peritonitis (inflammation of the lining of the inner abdomen and outer surfaces of the organs within the abdomen).

During a review of the County of Los Angeles Department of Health Services, "Diversion Request Requirements for Emergency Department Saturation," revised 4/1/2022, this document indicated that the ambulance offload time-time from when the patient arrives at the facility and is placed on facility bed/gurney or other acceptable location and the ED assumes responsibility for the patient, should be within 30 minutes, 90 % (percentage) of the time.

During a review of the facility's policy and procedure (P&P), titled "Admission to the Emergency Department," dated 1/18/2022, the P&P indicated, "To provide prompt medical assessment and treatment of patients who present for evaluation off illness and/or injury."

During a review of the facility's policy and procedure (P&P), titled "Radiographic Contrast Media," dated 4/16/2019, indicated "Insummary, the process for safe admisnitration of contrast media (used in imaging techniques to enhance the differences between body tissues on images) begins prior to administration and will include: A. Presence of risk factors identified and addressed..."