HospitalInspections.org

Based on review of facility documents, an ambulance audio recording encounter, interview with facility staff (EMP) and ambulance personnel (OTH), it was determined the facility failed to provide an appropriate medical screening examination to determine whether or not the patient was stable for transfer to another facility for one of one patients (PT1).

Findings include:

Review on January 29, 2013, of the facility's "Transfer or Discharge of Unstable Individuals to Another Institution" policy, last reviewed/revised February 29, 2012, revealed "Policy: It is the policy of Evangelical Community Hospital (ECH) to provide patient care in accordance with the Consolidated Omnibus Budget Reconciliation Act of 1985, and 55 PA Code CH. 1181 COBRA Transfers and Discharges. ... ECH will: 1) provide necessary examination and treatment to stabilize the patient; 2) follow established guidelines for transfer of the patient to another medical facility. Purpose: To assure that ECH patients arriving are offered medical stabilization within the capabilities of the Hospital prior to being transferred or discharged to another institution. ... Definitions: ... 2) The term "to stabilize" - means with respect to an emergency medical condition described in paragraph (1)(a), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility ... Procedure: I. Factors Restricting Transfers Until Individual is Stabilized: An individual determined to have a medical emergency condition who had not been stabilized may not be transferred or discharged unless either A or B below is performed and the transfer meets the guidelines of an appropriate transfer as established in Section II of Procedure. ...II. Appropriate Transfer: Prior to transferring an individual to another medical facility, ECH will confirm: A. The individual receives medical treatment within the capabilities of Evangelical Community Hospital to minimize risks to the patient's health ..."

Review on January 28, 2013, of the audio recording encounter dated December 29, 2012, revealed Emergency Management Service (EMS) notified the facility of PT1's complaint of chest pain. CF1 acknowledged the receipt of PT1 and stated the facility was not able to care for this patient. Further review of this recording revealed EMS notified CF1 the ambulance was pulling into the front of the hospital and that EMS requested clarification from CF1 instructing EMS to take PT1 to another hospital.

The facility was not able to provide documentation that CF1 assessed and determined PT1 was medically stable for transport to another facility.

Interview with EMP1, EMP2, and EMP3 on January 28, 2013, at approximately 3:30 PM confirmed the audio recording that EMS notified the facility of PT1's complaint of chest pain; CF1 acknowledged the receipt of this patient; and CF1 stated the facility was not able to care for PT1. Further interview with EMP1, EMP2 and EMP3 confirmed OTH1 notified CF1 the ambulance was pulling into the front of the hospital and OTH1 requested clarification from CF1 instructing EMS was to take this patient to another hospital. EMP1 and EMP2 confirmed the facility was not able to provide documentation that CF1 assessed and determined PT1 was medically stable for transport to another facility. EMP1 and EMP2 confirmed the facility was not on Divert or Bypass status at the time EMS was bringing PT1 to the emergency department.

Phone interview with OTH1 on January 29, 2013, at approximately 10:00 AM confirmed ambulance personnel notified the facility of PT1's complaint of chest pain; CF1 acknowledged the receipt of this patient; and CF1 stated the facility was not able to care for PT1. Further interview revealed OTH1 notified CF1 the ambulance was pulling into the front of the hospital and that OTH1 requested clarification from CF1 that the ambulance was to take this patient to another hospital.

Interview on January 31, 2013, at 3:45 PM with CF1 revealed they were working in the ED on December 29, 2012. CF1 was responsible for seeing patients and for covering the Medical Command calls. CF1 stated the facility was not in a divert status on December 29, 2012. CF1 did transfer patients to other facilities on December 29, 2012. CF1 received the call from a paramedic from an ambulance company. The patient's complaint was chest pain. CF1 obtained the patient's name during this call. CF1 stated the paramedic stated they were 30 minutes away at the time of the first call. CF1 looked up the past visits of this patient and saw the patient was seen in the Evangelical Community Hospital ED on December 27, 2012, for the same complaint. On December 27, 2012, the patient was transferred to [another hospital] for dialysis. Evangelical Community Hospital does not provide dialysis. CF1 requested the paramedic call back to the command center. CF1 stated the second call was made 20 minutes after the first call. During the second call CF1 told the paramedic to take the patient to [another hospital] for dialysis. CF1 thought the ambulance was at least ten minutes away because of the timing of the calls. CF1 stated it was their impression the patient was not on the campus of Evangelical Community Hospital.

Based on review of facility documents, an ambulance audio recording encounter, interview with facility staff (EMP) and ambulance personnel (OTH), it was determined the facility failed to provide an appropriate medical screening examination to determine whether or not the patient was stable for transfer to another facility for one of one patients (PT1).

Findings include:

Review on January 29, 2013, of the facility's "Transfer or Discharge of Unstable Individuals to Another Institution" policy, last reviewed/revised February 29, 2012, revealed "Policy: It is the policy of Evangelical Community Hospital (ECH) to provide patient care in accordance with the Consolidated Omnibus Budget Reconciliation Act of 1985, and 55 PA Code CH. 1181 COBRA Transfers and Discharges. ... ECH will: 1) provide necessary examination and treatment to stabilize the patient; 2) follow established guidelines for transfer of the patient to another medical facility. Purpose: To assure that ECH patients arriving are offered medical stabilization within the capabilities of the Hospital prior to being transferred or discharged to another institution. ... Definitions: ... 2) The term "to stabilize" - means with respect to an emergency medical condition described in paragraph (1)(a), to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility ... Procedure: I. Factors Restricting Transfers Until Individual is Stabilized: An individual determined to have a medical emergency condition who had not been stabilized may not be transferred or discharged unless either A or B below is performed and the transfer meets the guidelines of an appropriate transfer as established in Section II of Procedure. ...II. Appropriate Transfer: Prior to transferring an individual to another medical facility, ECH will confirm: A. The individual receives medical treatment within the capabilities of Evangelical Community Hospital to minimize risks to the patient's health ..."

Review on January 28, 2013, of the audio recording encounter dated December 29, 2012, revealed Emergency Management Service (EMS) notified the facility of PT1's complaint of chest pain. CF1 acknowledged the receipt of PT1 and stated the facility was not able to care for this patient. Further review of this recording revealed EMS notified CF1 the ambulance was pulling into the front of the hospital and that EMS requested clarification from CF1 instructing EMS to take PT1 to another hospital.

The facility was not able to provide documentation that CF1 assessed and determined PT1 was medically stable for transport to another facility.

Interview with EMP1, EMP2, and EMP3 on January 28, 2013, at approximately 3:30 PM confirmed the audio recording that EMS notified the facility of PT1's complaint of chest pain; CF1 acknowledged the receipt of this patient; and CF1 stated the facility was not able to care for PT1. Further interview with EMP1, EMP2 and EMP3 confirmed OTH1 notified CF1 the ambulance was pulling into the front of the hospital and OTH1 requested clarification from CF1 instructing EMS was to take this patient to another hospital. EMP1 and EMP2 confirmed the facility was not able to provide documentation that CF1 assessed and determined PT1 was medically stable for transport to another facility. EMP1 and EMP2 confirmed the facility was not on Divert or Bypass status at the time EMS was bringing PT1 to the emergency department.

Phone interview with OTH1 on January 29, 2013, at approximately 10:00 AM confirmed ambulance personnel notified the facility of PT1's complaint of chest pain; CF1 acknowledged the receipt of this patient; and CF1 stated the facility was not able to care for PT1. Further interview revealed OTH1 notified CF1 the ambulance was pulling into the front of the hospital and that OTH1 requested clarification from CF1 that the ambulance was to take this patient to another hospital.

Interview on January 31, 2013, at 3:45 PM with CF1 revealed they were working in the ED on December 29, 2012. CF1 was responsible for seeing patients and for covering the Medical Command calls. CF1 stated the facility was not in a divert status on December 29, 2012. CF1 did transfer patients to other facilities on December 29, 2012. CF1 received the call from a paramedic from an ambulance company. The patient's complaint was chest pain. CF1 obtained the patient's name during this call. CF1 stated the paramedic stated they were 30 minutes away at the time of the first call. CF1 looked up the past visits of this patient and saw the patient was seen in the Evangelical Community Hospital ED on December 27, 2012, for the same complaint. On December 27, 2012, the patient was transferred to [another hospital] for dialysis. Evangelical Community Hospital does not provide dialysis. CF1 requested the paramedic call back to the command center. CF1 stated the second call was made 20 minutes after the first call. During the second call CF1 told the paramedic to take the patient to [another hospital] for dialysis. CF1 thought the ambulance was at least ten minutes away because of the timing of the calls. CF1 stated it was their impression the patient was not on the campus of Evangelical Community Hospital.