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The hospital failed to ensure all patients who entered the emergency department (ED) knew their rights under section 1867 of the Social Security Act, were entered into the central log, and received an appropriate medical screening examination.

Based on interview and document review, the hospital failed to maintain an accurate and complete central log on each individual who presented to the emergency department (ED) for 1 of 23 patients (P1) who presented to the ED.

Findings include:

The hospital's ED central log was reviewed for patients that presented 8/29/19, through 8/31/19. P1 was not listed in the ED central log.

Chief Operations Officer (COO)- B was interviewed on 9/30/19, at 3:40 p.m. and said she was notified by another hospital that P1 came to their hospital after ED staff in Ely had referred P1 there to have an ultrasound. Review of medical record documentation and central log revealed P1 was not entered on the central log, had not been triaged, and had no medical screening examination (MSE). COO-B stated she had received conflicting information from registered nurse (RN)-E and Physician-J when they were interviewed by hospital administration.

On 10/1/19, at 7:20 a.m. RN-E was interviewed. RN-E stated P1 presented to the ED later in the evening between 7:00 p.m. and 10:00 p.m. with groin/testicular injury. RN-E stated she did not enter P1 on the ED central log, and she did not conduct an assessment, nor was P1 seen by Physician-J and had no MSE. RN-E said she did not know when an individual presents to the ED, they needed to be entered into the ED log. RN-E stated she had talked with Physician-J who said P1 could not get an ultrasound at this hosptial as they were not able to provide this. RN-E stated she was concerned P1 needed to be seen for quickly for treatment.

On 10/1/19, at 11:53 a.m. Physician-J was interviewed, and stated P1 presented to the ED, and was provided options regarding services and costs by the nurse. Physician-J stated he did not see P1. Physician-J stated RN-E had asked him about an ultrasound, and he replied there was no ultrasound at this hospital. Physican-J stated P1 was not triaged by the nurse, and he did not complete a MSE. Physician-J acknowledged P1 should have been seen but was not.

Review of facility EMTALA Policy N. C201, revised 9/12/19, directed, "All individuals presenting to the ED must be registered in the ED log and offered a medical screening exam."

Based on interview and document review the hospital failed to provide all patients that present to the emergency department (ED) with an appropriate medical screening examination for 2 of 23 (P1, P15) patients who presented to the ED. Findings include:

P15:
A review of the ED central log indicated P15 presented to the ED due to an acute psychological need on 7/2/19, at 4:09 p.m.

A review of P15's ED record revealed P15 was triaged by the nurse at 4:36 p.m. Review of the emergency room history and physical (H&P) completed 7/2/19, at 4:46 p.m. revealed P15 had worsening anxiety with long-standing fixed delusion regarding widespread mold contamination throughout his home, car, and his person (inside and outside of his body). The patient reported not having food or fluid intake for the last 24 hours due to the persistent delusion that all food and fluids were contaminated with mold. On 7/2/19, at 9:46 p.m. P15 was transferred to ED Border status as the ED was waiting for placement at a facility appropriate to assist R15 with his psychological needs. Further review of the ED record showed that there was no ongoing monitoring or assessment of R15 from 9:46 p.m. until 7/3/19, at 7:09 a.m. when registered nurse (RN)-E documented "Pt [patient] slept most of the shift and was cooperative when awake. Pt still awaiting psych placement." The ED record showed that there had not been vital signs taken or a comprehensive reassessment of R15 until 7/3/19, at 9:40 a.m. when P15 had vital signs checked and a comprehensive reassessment of body systems. R15 was discharged to an accepting psych facility on 7/3/19, at 1:53 p.m.

The RN ER Manager/Trauma Coordinator was interviewed on 10/2/19, at 11:40 a.m. and stated that he had identified the Ely Bloomenson ED did not have policy's that addressed ongoing monitoring and assessment of ED patients who were acute and ongoing monitoring and assessment of ED patients who were classified as an "ED Border." The RN ER Manager/Trauma Coordinator stated that he developed a policy titled Ely-Bloomenson Community Hospital ED STANDARD OF CARE so every ED patient was monitored and assessed according to current industry standards. The RN ER Manager/Trauma Coordinator confirmed that R15 would have been considered an ED Border on 7/2/19, at 9:46 p.m. and R15 should have had vital signs and a comprehensive reassessment every four hours until leaving the ED. The RN ER Manager/Trauma Coordinator confirmed that R15's ED record should show that R15 was monitored and reassessed every four hours. The RN ER Manager/Trauma Coordinator confirmed R15's ED record did not show that R15 had been reassessed every four hours according to the Ely-Bloomenson Community Hospital ED STANDARD OF CARE policy.

The policy Ely-Bloomenson Community Hospital ED STANDARD OF CARE undated, related to ongoing monitoring and patient reassessment still in "DRAFT" form identified that the patient would be monitored and reassessed according to the level of triage the ED patient was classified, however, the longest period of time between reassessments was identified as four hours while in the ED. Additionally, the RN ER Manager/Trauma Coordinator confirmed the Ely-Bloomenson Community Hospital ED STANDARD OF CARE policy had not been reviewed and signed by the medical staff and governing body.



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P1:
Review of the emergency department's (ED) central log revealed P1 was not on the log for 8/30/19.

Review of the hospital's electronic medical record revealed no medical record documentation for P1 on 8/30/19.

Review of the second hospital's medical record documentation called: "ED in Essential Health-Virginia Emergency Department" notes for P1 revealed P1 presented to the second hospital on 8/30/19, at 11:31 p.m., arrived by car to the ED. P1's chief complaint was scrotal pain. Review of the physician's Emergency Room Report of 8/31/19, at 12:48 a.m. indicates that P1 stated he had right groin pain rated 8/10, sharp in nature but also dull at times. The report continued, "P1 went to the Ely hospital and they referred him here. There was no transfer." The second hospital provided P1 with pain medication, conducted a urinalysis, blood work and an ultrasound of both testes/scrotum. Urinalysis and labs were normal and ultrasound revealed no evidence of any acute testicular or scrotal pathology. The provider diagnosed P1 with groin strain, right side.

On 10/1/19, at 11:53 a.m. Physican-J stated P1 presented and was provided options regarding services and costs by the nurse. Physician-J stated he did not see P1. Physician-J stated RN-E asked him about an ultrasound, but there was no ultrasound at this hospital. Physician-J stated P1 was not triaged by the nurse, and he did not conduct a MSE. Physician-J acknowledged P1 should have been seen by himself, but he was not.