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Based on interview, record and document review, the facility failed to comply with 42 CFR 489.24 by not providing a complete medical screening examination to 2 of 20 patients (Patients 3 and 13) who both arrived to the emergency department with heart rate over 100 beats per minute and were triaged lower that their triage algorithm dictated.

Findings include:

1. On September 26, 2011, the records of Patients 3 and 13 were reviewed. Both patients arrived to the emergency department with heart rates higher than 100 beats per minutes which per the hospital's "ESI Triage Algorithm" would be considered a "danger zone vital" and the hospital is directed to "consider 2" as a traige category. Both patients were triaged at lower categories (See A2406).

Based on interview, record and document review, the facility failed to provide an appropriate medical screening examination to 2 of 20 patients (Patients 3 and 13) who both arrived to the emergency department with heart rate over 100 beats per minute and were triaged lower that the hospital's triage algorithm dictated.

Findings include:

1. Patient 3 is 18 years old and according to her medical record arrived to the emergency department on September 23, 2011 at 5:33P.M. with a chief complaint of shortness of breath and right side pain in the chest. Patient 3's vital signs were taken at 5:37P.M. and read " blood pressure: 156/61, O2 (oxygen) saturation: 98, pain: 7, pulse: 172, respirations 18, temperature 97.4, weight 291.80." Patient 3 was triaged as a "3" meaning "urgent."
A review of the hospital's "ESI Triage Algorithm" that the hospital uses as a tool to triage patients under line item "D" "danger zone vitals?...greater than 8 y(ears)/ greater than 100 HR....consider 2"
2. Patient 13, a 29 year old female, presented to the emergency department on July 31, 2011 at 7:37 P.M. with a chief complaint of "aches, chills, fever." Patient 13's vital signs were taken at 5:37P.M. and read " blood pressure: 157/90, O2 (oxygen) saturation: 98, pain: 2, pulse: 107, respirations 18, temperature 101, weight 194.80." Patient 13 was triaged as a "5" meaning "routine."
A review of the hospital's "ESI Triage Algorithm" that the hospital uses as a tool to triage patients under line item "D" "danger zone vitals?...greater than 8 y(ears)/ greater than 100 HR....consider 2"

The triage nurse on duty was asked to review Patient 13's record and when would this patient be traiged higher than a "5" to which she replied, "I wouldn't place her at a five."