HospitalInspections.org

Based on record review and interview, the hospital failed to ensure compliance with the requirements of CFR 489.24 as evidenced by:

1) failing to provide a medical screening exam on all patients that presented to the emergency department with an emergency complaint for 1 (#2) of 21 (#1-21) patients sampled. This deficient practice is evidenced by Patient #2 not receiving a medical screening exam after presenting to the ED seeking medical treatment (see findings tag C-2406).


2) failing to ensure a central log was maintained on each individual who came to the ED seeking emergency assistance. This deficient practice was evidenced by failure to have a patient who presented for ED services included in the ED log for 1 (#2) of 21 (#1-21) sampled patient records reviewed (see findings tag C-2405).


3) failing to ensure signage (in a form specified by the Secretary) specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor; was posted conspicuously, in the emergency department and places likely to be noticed by all individuals entering the emergency department. This deficient practice was evidenced by failure to post EMTALA signage outside of the emergency department's ambulance bay, inside by the ambulance bay, or in the treatment area in the emergency department (see findings tag C-2402).

Based on observation and interview, the hospital failed to ensure signage (in a form specified by the Secretary) specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor; was posted conspicuously, in the emergency department, and places likely to be noticed by all individuals entering the emergency department. This deficient practice was evidenced by failure to post EMTALA signage outside of the emergency department's ambulance bay, inside by the ambulance bay, or in the treatment area in the emergency department.

Findings:

On 04/19/2022 at 10:00 a.m. an observation of the ambulance entrance to the emergency department failed to reveal any EMTALA signage outside of the emergency department's ambulance bay, inside by the ambulance bay, or in the treatment area in the emergency department patients to see if entering via ambulance.

In an interview on 04/19/2022 at 10:00 a.m. S2DON and S3RiskMgr verified there was no EMTALA Patient Rights signs posted outside of the emergency department's ambulance bay, inside by the ambulance bay, or in the treatment area in the emergency department for patients to see if entering via ambulance.

Based on record review and interviews, the hospital failed to maintain an accurate and complete Emergency Department Central (patient) Log on each individual who came to the Emergency Department as evidenced by failing to document in the central log a patient who presented seeking medical attention for an obstetrical issue for 1 (#2) of 21 (#1-20) patients sampled.

Findings:

A review of the ED Log for the dates March 15, 2022 through April 18, 2022; Left without being seen between 11/01/201 through 04/18/ 2022; and transfer logs between 11/01/2022 and the complaint/ grievance log failed to reveal Patient #2.

In an interview on 04/19/2022 at 1:15 p.m. S7MR stated if a patient checks in but does not complete triage the record is deleted from the ED log. S7MR stated all deleted records are deleted from the emergency department log but she could look up a specific patient by name. S7MR pulled up the report of all patients with the same last name as Patient #2 and I noted noted Patient #2's name. S7MR opened the records and she stated it was a record that was deleted because the patient was never triaged. The record revealed Patient #2 checked in on 04/02/2022 at 4:00 p.m.. There was no complaint identified and she was never triaged or completed the admission process. S7MR stated the stated she switched computer programs in 2019 and she was deleting the ED patients who never completed the registration process nor were triaged. She also stated she could not run a report to know how many patients had been deleted.

In an interview on 04/19/2022 at 2:25 p.m. S2DON presented a document printed from the ED Registration process showing Patient #2 presented to the ED on 04/02/2022 at 4:02 p.m. and the record was deleted on 04/02/2022 at 4:03 p.m. by S6Clk. S6Clk also documented a note stating: Set visit 47078 deleted note to patient opted not to be seen since facility does not have ultrasound or OB. Per S5RN.

On 04/25/2022 at 11:50 a.m. S2DON reviewed Patient #2's Medical Record dated 04/02/2022 and verified Patient #2 was not on the ED Log and Patient #2 did not receive a medical screening exam prior to leaving the ED.

In a telephone interview on 04/28/2022 at 8:53 a.m. S6Clk stated she remembered Patient #2 coming to the emergency department with an OB concern. She also remembered S5RN speaking with Patient #2 prior to triage and Patient #2 leaving the emergency department without being triaged or completing a medical screening exam.

Based on record review and interview, the hospital failed to provide a medical screening exam on all patients who presented to the emergency department with an emergency complaint for 1 (#2) of 21 (#1-21) patients sampled. This deficient practice is evidenced by Patient #2 presenting to the emergency department seeking medical treatment for an OB issue, speaking with S5RN and then leaving the emergency department without receiving a medical screening exam because the hospital does not provide ultrasound and OB services.

Findings:

In an interview on 04/19/2022 at 2:25 p.m. S2DON presented a document printed from the ED Registration process showing Patient #2 presented to the ED on 04/02/2022 at 4:02 p.m. and the record was deleted on 04/02/2022 at 4:03 p.m. by S6Clk. S6Clk also documented a note stating: Set visit 47078 deleted note to patient opted not to be seen since facility does not have ultrasound or OB. Per S5RN.

On 04/25/2022 at 11:50 a.m. S2DON reviewed Patient #2's Medical Record dated 04/02/2022 and verified Patient #2 did not receive a medical screening exam prior to leaving the ED.

In a telephone interview on 04/28/2022 at 8:53 a.m. S6Clk stated she remembered Patient #2 coming to the emergency department with an OB concern. She also remembered S5RN speaking with Patient #2 prior to triage and Patient #2 leaving the emergency department without being triaged or completing a medical screening exam.

A review of Patient #2's medical record from Hospital A revealed Patient #2 presented to the emergency room on 04/02/2022 at 7:22 p.m. with a chief complaint of pregnant with last cycle on December 11, 2021. State had a miscarriage in November, 2021. She reports had some spotting today, not enough to fill a pad.
Patient #2 received a physical exam, urinalysis, urine pregnancy test, CMP, HCG- Quantitative, CBC and ultrasound.
Patient #2 was diagnosed with 2nd or 3rd trimester limited, 1 or more Fetuses, 13 weeks IUP, threatened miscarriage and Acute cystitis without hematuria.
Patient #2 was discharged with medications and plan to follow up with her MD as soon as possible in 2 days.