HospitalInspections.org

Based on record review and interview, the facility failed to ensure, all patients that arrive at the Emergency Room are in entered into the Emergency Room Log, a Medical Screening Exam is performed on all patients that arrive at the facility and transfer documents are complete with risks and benefits. The cumulative effect of these deficiencies directly affect Patients 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20, and potentially affect all patients requesting emergency treatment at the facility.

Findings include:

The facility failed to ensure all patients that present to the Emergency Room are entered into the Emergency Room Log, 1 of 1 Emergency Room Logs reviewed (dated 12/1/16 to 6/12/17). See tag C2405.

The facility failed to ensure patients received a Medical Screening Exam to rule out a medical emergency upon arrival to the Emergency Room, in 1 of 20 medical records reviewed(#1). See tag C2406.

The facility failed to ensure transfer documents are completed, including risks and/or benefits of the transfer documented for patients referred to other facilities, in 19 of 20 medical records reviewed (#1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20). See tag C2409.

Based on record review and interview, the facility failed to ensure all patients that present to the Emergency Room are entered into the Emergency Room Log, in 1 of 1 Emergency Room Logs reviewed (dated 12/1/16 to 6/12/17). This deficiency directly affects Patient #1 and potentially affects all patients that arrive in the Emergency Room.

Findings include:

Per review of facility policy titled Admission of Patient, revised 01/14, it states under 2. "...After hours, patient will be registered and admitted by nursing staff..."

Per review on 6/7/17 at 8:00 AM, of Patient #1's medical record from the receiving hospital, the Medical Transport report dated 4/29/17, completed by the helicopter crew, states "On arrival we were instructed that we were intercepting with the ambulance in the ER (Emergency Room), the pt. (patient) had not been admitted to the hospital and was still being cared for by the ambulance crew."

During patient record review selection via this facility's Emergency Room Log, on 6/12/17 between 10:30 AM and 10:50 AM, there is no entry in the log of Patient #1's arrival in the Emergency Room on 4/29/17. This is confirmed in interview with Registered Nurse D on 6/12/17 during record review during record review at 10:50 AM, adding nurses are responsible to register patients when they arrive after hours.

Based on record review and interview the facility failed to ensure patients received a Medical Screening Exam to rule out a medical emergency upon arrival to the Emergency Department, in 1 of 20 medical records reviewed (#1). This deficiency directly affects Patient #1 and potentially affects all patients that arrive in the Emergency Department.

Findings include:

Per review of facility policy titled Medical Screening & Emergency Medical Treatment, dated 3/07, it states under III. 1. "If an individual: a. Presents at the "Dedicated Emergency Department", and b. Requests examination or treatment for medical condition; or c. Has a request for examination or treatment for a medical condition made on his or her behalf; or d. In the absence of a request, a prudent layperson observer would believe, based on the individual's appearance or behavior, that the individual needs examination or treatment for a medical condition. 2. Then the Dedicated Emergency Department will provide a Medical Screening to determine if the individual has an emergency medical condition, and provide any necessary Stabilizing Treatment..."

Per review on 6/7/17 at 8:00 AM, of Patient #1's medical record from the receiving hospital, the Medical Transport report, dated 4/29/17, completed by the helicopter crew, states "On arrival we were instructed that we were intercepting with the ambulance in the ER (Emergency Room), the pt. (patient) had not been admitted to the hospital and was still being cared for by the ambulance crew."

Per review of the facility's Emergency Room Log for 4/29/17, there is no record of Patient #1 arriving in the Emergency Room, this is confirmed in interview with Registered Nurse D on 6/12/17 at 10:50 AM.

Per interview with Physician E on 6/12/17 at 1:52 PM, Physician E began the interview stating "I was in the Emergency Department with two patients, first of all (s/he) wasn't supposed to come in the ED (Emergency Department)". Physician E added "They (Emergency Medical Technicians) decided to bring the patient in, I don't know why." Physician E stated in interview "I told the nurses the patient should not come into the ED." When informed that a patient must have a Medical Screening Exam if they are brought into the Emergency room, Physician E said "I did not know that."

Based on record review and interview, the facility failed to ensure transfer documents are completed, including risks and/or benefits of the transfer documented for patients referred to other facilities, in 19 of 20 medical records reviewed (#1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20). This deficiency directly affects Patients #1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20, and potentially affects all patients that arrive in the Emergency Room.

Findings include:

Per review of facility policy titled Medical Screening & Emergency Medical Treatment, dated 3/07, it states under VI. C. 2. "A physician has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medial (sic) treatment at another medial (sic) facility outweigh the increased risks to the patient (or to the woman or unborn child, in the case of a woman in labor) of the Transfer. The Certification must contain a summary of the risks and benefits upon which it is based...E. Transfer Procedures: the following procedures must be followed for all Transfers: 1. The Hospital shall provide medical treatment within its capacity that minimizes the risks to the patient's health (and the health of the child in the case of a woman in labor). 2. The hospital staff shall confirm that the receiving facility has available space and qualified personnel for the treatment of the patient and has agreed to accept Transfer of the patient and to provide appropriate medical treatment. 3. The hospital shall send to the receiving facility all medical records (or copies thereof) related to the Emergency Medical Condition, including available history, records related to the individuals Emergency Medical Condition, observations of signs or symptoms, preliminary diagnosis, results of diagnostic studies or telephone reports of the studies, treatment provided, results of any test and the informed written consent or certification (or copy thereof), and the name and address of any on-call physician who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment. Other records (i.e., test results not yet available or historical records not readily available from the Hospital's files) must be sent as soon as practicable after Transfer. 4. The Transfer shall be effected through qualified personnel and transportation equipment, as required."

Per review on 6/7/17 at 8:00 AM, of Patient #1's medical record from the receiving hospital, the Medical Transport report, dated 4/29/17, completed by the helicopter crew, states "On arrival we were instructed that we were intercepting with the ambulance in the ER (Emergency Room), the pt. (patient) had not been admitted to the hospital and was still being cared for by the ambulance crew."

Per review of the facility's Emergency Room Log for 4/29/17, there is no record of Patient #1 arriving in the Emergency Room, this is confirmed in interview with Registered Nurse D on 6/12/17 at 10:50 AM.

Per telephone interview with Registered Nurse G on 6/12/17 at 3:55 PM, Nurse G said s/he went to help in the Emergency Room. The ambulance came with the patient and brought Patient #1 into the Emergency Department. Nurse G said "I went to talk to the patient. (S/he) seemed scared, I took vitals (blood pressure, temperature, pulse and respirations), and told (Patient #1) the flight crew was coming to take (Patient #1) to the other hospital..." Nurse G stated s/he wrote down the vitals and gave them to the flight crew when they arrived. Per Nurse G, Physician E was in the Emergency Department and "he did not talk to (Patient #1) at all."

The following records were reviewed on 6/12/17 between 10:50 AM and 12:59 PM:

Patient #2's medical record review at 10:55 AM revealed Patient #2 arrived in the Emergency Department on 6/1/17 at 10:09 AM with a complaint a fractured wrist. The Transfer Certification dated 6/1/17 states under Benefits: "specialized care" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". The transfer document includes the following record copies sent as "Face Sheet" and "MD (physician) Progress Notes". Nursing notes dated 6/1/17 indicate the patient was transported via "private vehicle", with the data sent as "X-ray reports/copies", and state "pt (patient) d/c (discharged) with mother and father to (receiving hospital) for follow up treatment." There are no risks specific to the patient's condition, and traveling without medical staff, and no other documents are listed accompanying Patient #2 to the receiving facility.

Patient #3's medical record review at 11:03 AM revealed Patient #3 arrived in the Emergency Department on 6/4/17 at 3:40 AM with a complaint vaginal bleeding. The Transfer Certification dated 6/4/17 states under Benefits: "specialized care" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #4's medical record review at 11:13 AM revealed Patient #4 arrived in the Emergency Department on 5/24/17 at 8:32 AM with a complaint of difficulty breathing. The Transfer Certification dated 5/24/17 states under Benefits: "specialized care" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #5's medical record review at 11:20 AM revealed Patient #5 arrived in the Emergency Department on 5/26/17 at 4:17 AM with a complaint of rectal bleeding. The Transfer Certification dated 5/26/17 states under Benefits: "higher level of care, services not available at the facility" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #6's medical record review at 11:25 AM revealed Patient #6 arrived in the Emergency Department on 5/13/17 at 11:25 AM with a complaint of injuries after a motor vehicle crash. The Transfer Certification dated 5/13/17 states under Benefits: "specialized care" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #7's medical record review at 11:55 AM revealed Patient #7 arrived in the Emergency Department on 3/14/17 at 4:27 PM with a complaint of a painful hernia. The Transfer Certification dated 3/14/17 states under Benefits: "surgical consult" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #9's medical record review at 11:35 AM revealed Patient #9 arrived in the Emergency Department on 2/11/17 at 6:20 PM with a complaint of a seizure. The Transfer Certification dated 2/11/17 states under Benefits: "neurology consult" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #10's medical record review at 12:02 PM revealed Patient #10 arrived in the Emergency Department on 2/4/17 at 9:43 PM with a complaint of difficulty breathing. The Transfer Certification dated 2/4/17 states under Benefits: "surgical consult" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #11's medical record review at 12:10 PM revealed Patient #11 arrived in the Emergency Department on 1/3/17 at 7:32 AM with a complaint of chest pain. The Transfer Certification dated 1/3/17 states under Benefits: "cardiology cath(eter) lab" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". The transfer form has no documents listed accompanying the patient. There are no risks specific to the patient's condition.

Patient #12's medical record review at 12:15 PM revealed Patient #12 arrived in the Emergency Department on 1/9/17 at 2:00 AM with a complaint of chest pain. The Transfer Certification dated 1/9/17 states under Benefits: "specialized care" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #13's medical record review at 12:20 PM revealed Patient #13 arrived in the Emergency Department on 12/25/16 at 7:50 AM with a complaint of closed head injury. The Transfer Certification dated 12/25/16 states under Benefits: "surgery consult" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #14's medical record review at 12:41 PM revealed Patient #14 arrived in the Emergency Department on 12/5/16 at 12:41 PM with a complaint of a fall and bruising. The Transfer Certification dated 12/5/16 states under Benefits: "surgery consult" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #15's medical record review at 12:25 PM revealed Patient #15 arrived in the Emergency Department on 12/10/16 at 3:52 PM with a complaint of difficulty breathing. The Transfer Certification dated 12/10/16 states under Benefits: "increased level of care" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #16's medical record review at 12:40 PM revealed Patient #16 arrived in the Emergency Department on 12/16/16 at 6:21 PM with a complaint of fever. The patient requested a transfer to another facility. The Transfer Certification dated 12/16/16 states under Benefits: "specialized care/pt's request" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #17's medical record review at 12:45 PM revealed Patient #17 arrived in the Emergency Department on 1/29/17 at 12:08 PM with a complaint of weakness, facial droop and altered speech. The Transfer Certification dated 1/29/17 states under Benefits: "specialized care" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #18's medical record review at 12:47 PM revealed Patient #18 arrived in the Emergency Department on 1/30/17 at 8:21 AM with a complaint of shortness of breath. The Transfer Certification dated 1/30/17 states under Benefits: "specialized care" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #19's medical record review at 12:55 PM revealed Patient #19 arrived in the Emergency Department on 12/31/16 at 3:11 AM with a complaint of altered mental status. The Transfer Certification dated 12/31/16 states under Benefits: "specialized care" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

Patient #20's medical record review at 12:59 PM revealed Patient #20 arrived in the Emergency Department on 12/26/16 at 5:39 PM with a complaint of difficulty breathing. The Transfer Certification dated 12/26/16 states under Benefits: "specialized care" and under Risks it states "The inherent risks which can be reasonable anticipated by the transportation of the above patient include: the general risks associated with all transportation, such as possible failure of medical equipment, aircraft or vehicle, traffic hazards, adverse weather conditions, pilot or driver error, interruption of medical treatment during transportation, or consequences of actions of persons outside the control of transport personnel. The risks associated with all transports, because of patient's condition, include the possible worsening of the patient's condition during transport". There are no risks specific to the patient's condition.

The above records are confirmed in interview during record review on 6/12/17 between 10:50 AM and 12:59 PM with Registered Nurse D who also agreed, all chart documents should accompany the patients, and was not aware risks should be specific to the patient's condition/diagnosis.