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Based on review of Hospital policies, review of the Hospital's Central Emergency Department (ED) Log, clinical record review and staff interview, it was determined that in 1 of 20 (Pt #1) clinical records reviewed, the Hospital failed to ensure that all patients presenting to the Hospital's ED receive a Medical Screening Exam; see CFR 489.24(r) and 489.24(c), and failed to ensure all transfers of patients were conducted as per requirement; see CFR 489.24 (e)(1)-(2).

A. Based on review of Hospital policy, review of the Hospital's Central Emergency Department Log (ED), and staff interview, it was determined that in 1 of 1 Central ED Log, the Hospital failed to ensure all entries were complete.

Findings include:

1. Hospital policy entitled, "Triage," reviewed on survey date 11/8/10 at approximately 10:15 AM required, "Procedure: I. General Guidelines: ..11. Records and Records Retention: A centralized log of all patients presenting to the ED shall be maintained and include the name of the patient, outcome, any refusal of care and patient was transferred, admitted, or discharge."

2. On survey date 11/8/10 at approximately 9:45 AM the Hospital's Central ED Log was reviewed. The log entry dated 10/30/10 contained an entry for Pt #1. However the entry lacked diagnosis and final disposition.

3. The finding was confirmed by the Director of Quality and Risk Management during an interview on survey date 11/9/10 at approximately 11:00 AM.

A. Based on review of Hospital policies, clinical record review, and staff interview, it was determined that in 1 of 20 (Pt #1) clinical records reviewed, the Hospital failed to ensure a Medical Screening Exam was conducted on all patients presenting to the Emergency Department.

Findings include:

1. Hospital policy entitled, "Triage," reviewed on survey date 11/8/10 at approximately 10:15 AM required, "Procedure: I. General Guidelines: 1. Medical Screening: All patients coming to the hospital requesting emergency care (or where such request are made on their behalf) shall receive an appropriate medical screening ...."

2. Hospital policy entitled, "Triage and Admission to the Emergency Department," reviewed on survey date 11/8/10 at 10:30 AM required, "Purpose: To ensure that all patients who present for treatment in the emergency department are assessed and prioritized for a timely evaluation based on the severity of their presentation ...Psychiatric Patients, Violence and Sexual Assault Victims: 1. All patients presenting with psychiatric complaints will receive a medical screening clearance exam prior to consulting with psychiatric services."

3. The clinical record of Pt #1 was reviewed on survey date 11/9/10 at 8:45 AM. Pt #1 was a 55 year old male who presented to the ED on 10/30/10 at 5:40 PM and left the ED on 10/30/10 at 5:46 PM. The clinical record lacked documentation of a medical screening exam.

4. On 11/8/10 at approximately 11:00 AM the Triage Nurse on duty 10/30/10 was interviewed. During the interview, the nurse stated that on 10/30/10 at approximately 5:30 PM, Pt #1 was transported to the Hospital's ED by Superior Ambulance Service. Upon arrival the nurse discovered that Pt #1 had a 5 and 6 (petition and certification for involuntary psychiatric admission forms) filled out with instructions to go to Swedish American Hospital for psychiatric services. According to the triage nurse, Pt #1 was on a cart at the Triage window at the time. The Triage Nurse notified her charge nurse as well as the House Supervisor on duty, and stated that she was told to have Pt #1 transported to Swedish American Hospital, and that Pt #1 was not to receive a medical screening exam.

5. The findings were confirmed by the Director of Quality and Risk Management during an interview on survey date 11/9/10, at approximately 11:00 AM.