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Based on interview and record review it was determined the hospital did not maintain a central log for one (Patient #1) of 20 patients reviewed who went to the hospital emergency room for treatment. On 09/01/10 Patient #1 arrived in the emergency room with symptoms of vomiting, abdominal pain, nausea, and diarrhea. The patient had an upcoming surgery scheduled and after approximately ten minutes was never logged into the emergency room but instead was sent directly to the Day Surgery unit.

Findings included:

Patient #1's medical record reflected she was 39-years-old and presented to the ED of Medical Center of Arlington for symptomatic cholelithiasis which included abdominal pain, nausea, vomiting and diarrhea at approximately 09:50 AM on 09/01/10. Her past medical history included Depression, irritable bowel syndrome, diarrhea, sinus tachycardia, breast reduction surgery, left knee surgery, and cervical osteoarthritis. Her medications included Cymbalta (anti-depressant) and Hydrocodone. Allergies included IV Contrast and Benadryl.

Review of the Central Emergency Department (ED) logs dated 09/01/10, did not show Patient #1 was seen in the ED.

According to Patient #1's medical record she was admitted to Day Surgery per Personnel #4, a General Surgeon at approximately 10:00 AM (approximately 10 minutes after arriving to the ED) on 09/01/10. Verbal orders were received by Personnel #5, RN, Director of Surgical Services at 09:50 AM. from Personnel #4 for permit for laparoscopic cholecystectomy, stat KUB (x-ray for kidneys, ureters and bladder), CBC (complete blood count), CMP (comprehensive metabolic panel), Amylase, Lipase, PT & PTT (prothrombin time and partial thromboplastin time), INR (international normalized ratio), and Morphine 4 mg (milligrams) every 2 hours.

The History and Physical showed Patient #1 had an elevated white blood cell count at almost 20,000 along with dehydration. Personnel #4 elected to forgo surgery and admit the patient to the medical floor to treat the dehydration, place on IV antibiotics and obtain further tests. Patient #1 was admitted to the medical surgical unit, 3 North at 10:47 AM on 09/01/10.

On 09/02/10, a laparoscopic cholecystectomy was performed without any complications. Patient #1 was discharged home on 09/03/10 in stable condition to follow-up with her primary care physician.

At 3:30 PM on 10/21/10 the surveyor attempted to contact Patient #1 by telephone and left a message. Patient #1 never returned the call.

At 1:00 PM on 10/25/10, Personnel #4, General Surgeon was interviewed. Personnel #4 was asked if he requested Patient #1 to go to the Emergency Room (ER) on 09/01/10 to be seen. He stated, "Yes, I did. I had talked with her [family member] on and off for about a month regarding [the patient] wanting to have a cholecystectomy. She had all of her workup including an ultrasound since she is a nurse practitioner. I told her to come to the hospital since I was already doing surgery that day and would work her in. I then called the ER and spoke with Dr. [Personnel #3] and we discussed [Patient #1's] case. We decided since we already knew the definitive diagnosis and I already knew I was going to do surgery that we would directly admit her to Day Surgery to speed up the process. There really was no need for her to go through the ER since I already knew I would be doing surgery. I called the Day Surgery and let them know that [Patient #1] would be coming and gave them orders to admit her."

At 3:15 PM on 10/25/10, Personnel #5, RN, Director of Surgical Services was interviewed. Personnel #5 was asked if she checked Patient #1 into Day Surgery on 09/01/10. She stated, "I was in charge at the OR desk and received a call from [family member] stating that [Patient #1] was in the emergency room...[Patient #1]...was throwing up and that she was bringing [Patient #1] in because Dr. [Personnel #4] said he was going to see her."

At 9:00 AM on 10/26/10, Dr. [Personnel #3, Chief of Emergency Medicine was interviewed. Personnel #3 was asked if she refused to see Patient #1 in the Emergency Room on 09/01/10. She stated, "No, I received a phone call from Dr. [Personnel #4] regarding a patient of his, [Patient #1], that he had previously diagnosed with biliary colic and that she had already had her workup confirming the same. We discussed the various options for facilitating [Patient #1's] definitive care which was to be a laparoscopic cholecystectomy performed by him on that day. Since she already had her diagnosis we agreed that she could be registered as a day surgery outpatient and meet him in the Day Surgery (DSU) area where he was waiting for her. It was there that he performed the medical screening exam and continued care of the patient. Suring our telephone discussion, it was determined that it was not necessary for [Patient #1] to be re-evaluated by another physician in our ED and [she] was sent directly to DSU."

Based on interview and record review it was determined the hospital emergency room did not provide a medical screening to determine whether or not an emergency medical condition existed for one (Patient #1) of 20 patients reviewed who went to the hospital emergency room for treatment. On 09/01/10 Patient #1 arrived in the emergency room with symptoms of vomiting, abdominal pain, nausea, and diarrhea. The patient had an upcoming surgery scheduled that day and after approximately ten minutes in the emergency room was sent directly to the Day Surgery unit without being screened by a qualified medical person to ensure her condition was stable. She was later admitted to a medical surgical unit and placed on IV antibiotics and treat for dehydration.

Findings included:

Patient #1's medical record reflected she was 39-years-old and presented to the ED of Medical Center of Arlington for symptomatic cholelithiasis which included abdominal pain, nausea, vomiting and diarrhea at approximately 09:50 AM on 09/01/10. Her past medical history included Depression, irritable bowel syndrome, diarrhea, sinus tachycardia, breast reduction surgery, left knee surgery, and cervical osteoarthritis. Her medications included Cymbalta (anti-depressant) and Hydrocodone. Allergies included IV Contrast and Benadryl.

Review of the Central Emergency Department (ED) logs dated 09/01/10, did not show Patient #1 was seen in the ED.

According to Patient #1's medical record she was admitted to Day Surgery per Personnel #4, a General Surgeon at approximately 10:00 AM (approximately 10 minutes after arriving to the ED) on 09/01/10. Verbal orders were received by Personnel #5, RN, Director of Surgical Services at 09:50 AM from Personnel #4 for permit for laparoscopic cholecystectomy, stat KUB (x-ray for kidneys, ureters and bladder), CBC (complete blood count), CMP (comprehensive metabolic panel), Amylase, Lipase, PT & PTT (prothrombin time and partial thromboplastin time), INR (international normalized ratio), and Morphine 4 mg (milligrams) every 2 hours.

The History and Physical showed Patient #1 had an elevated white blood cell count at almost 20,000 along with dehydration. Personnel #4 elected to forgo surgery and admit the patient to the medical floor to treat the dehydration, place on IV antibiotics and obtain further tests. Patient #1 was admitted to the medical surgical unit, 3 North at 10:47 AM on 09/01/10.

On 09/02/10, a laparoscopic cholecystectomy was performed without any complications. Patient #1 was discharged home on 09/03/10 in stable condition to follow-up with her primary care physician.

At 3:30 PM on 10/21/10 the surveyor attempted to contact Patient #1 by telephone and left a message. Patient #1 never returned the call.

At 1:00 PM on 10/25/10, Personnel #4, General Surgeon was interviewed. Personnel #4 was asked if he requested Patient #1 to go to the Emergency Room (ER) on 09/01/10 to be seen. He stated, "Yes, I did. I had talked with her [family member] on and off for about a month regarding [the patient] wanting to have a cholecystectomy. She had all of her workup including an ultrasound since she is a nurse practitioner. I told her to come to the hospital since I was already doing surgery that day and would work her in. I then called the ER and spoke with Dr. [Personnel #3] and we discussed [Patient #1's] case. We decided since we already knew the definitive diagnosis and I already knew I was going to do surgery that we would directly admit her to Day Surgery to speed up the process. There really was no need for her to go through the ER since I already knew I would be doing surgery. I called the Day Surgery and let them know that [Patient #1] would be coming and gave them orders to admit her."

At 3:15 PM on 10/25/10, Personnel #5, RN, Director of Surgical Services was interviewed. Personnel #5 was asked if she checked Patient #1 into Day Surgery on 09/01/10. She stated, "I was in charge at the OR desk and received a call from [family member] stating that [Patient #1] was in the emergency room...[Patient #1]...was throwing up and that she was bringing [Patient #1] in because Dr. [Personnel #4] said he was going to see her."

At 9:00 AM on 10/26/10, Dr.[Personnel #3, Chief of Emergency Medicine was interviewed. Personnel #3 was asked if she refused to see Patient #1 in the Emergency Room on 09/01/10. She stated, "No, I received a phone call from Dr. [Personnel #4] regarding a patient of his, [Patient #1], that he had previously diagnosed with biliary colic and that she had already had her workup confirming the same. We discussed the various options for facilitating [Patient #1's] definitive care which was to be a laparoscopic cholecystectomy performed by him on that day. Since she already had her diagnosis we agreed that she could be registered as a day surgery outpatient and meet him in the Day Surgery (DSU) area where he was waiting for her. It was there that he performed the medical screening exam and continued care of the patient. Suring our telephone discussion, it was determined that it was not necessary for [Patient #1] to be re-evaluated by another physician in our ED and [she] was sent directly to DSU."