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Based on interview and record review, the facility failed to ensure that emergency medical services were provided in accordance with CFR §489.24, the regulations for the Emergency Medical Treatment and Active Labor Act (EMTALA).

The facility failed to provide a Medical Screening Examination (MSE) for one of 20 sampled patients (Patient 8) who came to the Emergency Department (ED) with a complaint of chest pain. This failure had the potential to put the patient at risk for potential life-threatening medical complications. (Refer to A2406)

Based on interview and record review, the facility failed to provide a Medical Screening Examination (MSE) for one of 20 sampled patients (Patient 8) who came to the Emergency Department (ED) with a complaint of chest pain. This failure had the potential to put the patient at risk for potential life-threatening medical complications.

Findings:

A facility policy titled, "Admission Policy/Emergency Medical Record," revised 2/1/20, was reviewed. Its purpose indicated to ensure that all patients who came to the hospital requesting emergency services received an appropriate MSE as required by the Emergency Medical Treatment and Active Labor Act (EMTALA).
All patients who presented to the ED would have been registered and received an MSE by an ED Provider. The MSE was to have been performed as soon as possible after patient arrival. Triage/intake (evaluating a patient to determine the urgency of their need for care) by a Registered Nurse (RN) was not an MSE.

Review of Patient 8's Emergency Department (ED) record indicated they walked into the ED on 1/25/24 shortly after midnight with a complaint of chest pains. Patient 8's triage priority was listed as "three," which indicated the patient's needs were urgent with the potential to increase, but not life-threatening. Under the Triage Vital Signs at 12:50 am, RN A documented a blood pressure value of 195/111 and a pain level of three out of 10 (on a zero to 10 scale, 10 being the worst pain, zero being no pain). Under Triage Comment RN A wrote: "left sided chest pressure onset few days, nonradiating (contained in one area), associated symptoms sob (shortness of breath)."

A document from the American Heart Association titled, "Blood Pressure Categories," dated 8/1/20 (available online at https://www.heart.org/en/health-topics/high-blood-pressure) was reviewed. The document contained a table of five blood pressure categories with corresponding numbers for systolic (upper number) and diastolic (lower number). A systolic number greater than 180 indicated a hypertensive (high blood pressure) crisis, and the reader was advised to consult a doctor immediately. A diastolic reading of 90 or higher indicated hypertension classified as "Stage 2."

An electrocardiogram (EKG- measures the electrical impulses of the heart to check for heart disease) result, dated 1/25/24 at 1:20 am, showed Patient 8 had an electronic atrial (top chambers of the heart) pacemaker, and Medical Doctor (MD) C reviewed and signed the EKG at 1:25 am.

Review of a Patient Audit Trail for Patient 8, dated 1/25/24, showed RN D wrote that Patient 8 was, "awaiting MD, awaiting room" at 3:26 am. The next note written by RN B at 6:21 am, read, "not in lobby." RN B documented three more checks for Patient 8, then, "Left Without Being Seen" at 6:51 am (six hours after arrival to the ED). There was no record of any MSE done for Patient 8.

During a concurrent interview and record review, on 5/31/24, at 11:30 am, RN B stated they didn't care for Patient 8 on 1/25/24, just did a roll call when they came on shift in the morning. RN A was triage nurse. It was unclear when Patient 8 left. RN B agreed a BP of 195/111 was high, and stated the triage nurse was always reassessing patients in the waiting room. RN B stated that when only one doctor worked on the night shift it was difficult for them to see all the patients without the help of a mid-level provider, such as a Physician's Assistant.

During a concurrent interview and record review, on 5/31/24, at 2:30 pm, the Director of Performance Improvement confirmed Patient 8 did not have an MSE documented and only had one BP reading documented on 1/25/24. MD C was the only doctor working on night shift from 10 pm 1/24/24 to 6 am 1/25/24. There was no surveillance camera footage available to determine what time Patient 8 left the ED lobby on 1/25/24.