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Based on record review and interview, the facility failed to ensure all patients treated by the emergency department (ED) were entered on the ED log. 1 of 21 patients (#1) was not entered on the ED log.


Findings include:

Review of an ambulance record for patient #1 revealed the following:

-on 3/15/13, patient #1 had breathing difficulty and contacted the ambulance service;

-initial evaluation by the ambulance personnel revealed the patient had breathing difficulty but no chest pain;

-during transport to facility #1, patient #1 had a change in his 12-lead electrocardiogram (EKG- a monitor of heart function), which indicated a possible myocardial infarction (MI- heart attack);

-facility #1 was contacted about this EKG change;

-when the ambulance arrived at facility #1 (7:39pm), staff #1 (the ED physician) met the ambulance and patient outside, in the ambulance parking area;

-staff #1 reviewed the EKG and reported that he had talked with a cardiologist at facility #2 and patient #1 should be transported there for appropriate care;

-staff #1 reported that the cardiologist would be waiting for patient #1 in the cardiac catheterization lab at facility #2;

-the EMS transported the patient to facility #2.


Review of the facility's ED log revealed no entry for patient #1.

During an interview on 3/25/13 at 1:00pm, staff #3 confirmed there was no ED log entry for patient #1.

Based on record review and interview, the facility failed to ensure all patients treated by the emergency department (ED) received a medical screening exam. There was no evidence 1 of 21 patients (#1) received a medical screening exam.

Findings include:

Review of an ambulance record for patient #1 revealed the following:

-on 3/15/13, patient #1 had breathing difficulty and contacted the ambulance service;
-initial evaluation by the ambulance personnel revealed the patient had breathing difficulty but no chest pain;

-during transport to facility #1, patient #1 had a change in his 12-lead electrocardiogram (EKG- a monitor of heart function), which indicated a possible myocardial infarction (MI- heart attack);

-facility #1 was contacted about this EKG change;

-when the ambulance arrived at facility #1 (7:39pm), staff #1 (the ED physician) met the ambulance and patient outside, in the ambulance parking area;

-staff #1 reviewed the EKG and reported that he had talked with a cardiologist at facility #2 and patient #1 should be transported there for appropriate care;

-staff #1 reported that the cardiologist would be waiting for patient #1 in the cardiac catheterization lab at facility #2;

-the EMS transported the patient to facility #2.

Review of the physician call schedule for 3/15/13 revealed no cardiology coverage at the time the patient arrived at facility #1.

During an interview on 3/25/13 at 1:05pm, staff #2 confirmed there was no cardiology coverage at the time the patient arrived at facility #1.

Review of staff #1's (ED physician) written statement revealed the following:

-staff #1 believed the patient needed a cardiac catheterization under the care of a cardiologist;

-while the ambulance was transporting the patient to facility #1, staff #1 placed a call to a cardiologist at the nearest facility (#2) and arranged for the patient to be treated there;

-before facility #1 could contact the ambulance and instruct them to bypass facility #1 and take the patient directly to facility #2, the ambulance arrived at facility #1;

-staff #1 evaluated the patient in the ambulance by reviewing the EKGs, taking the patient's vital signs (which were stable), listening to the patient's history, and checking the patient's heart and lung sounds;

-staff #1 felt the patient was stable for transport;

-staff #1 discussed with the patient the need for swift transport and evaluation at facility #2 and the patient "understood;"

-staff #1 believed it was in the patient's best interest to continue to facility #2 as quickly as possible.

Review of medical records revealed no record for patient #1 for 3/15/13. Therefore, there was no documented medical screening exam for patient #1.

During an interview on 3/25/13 at 1:00pm, staff #3 confirmed there was no medical record for patient #1 for 3/15/13.