HospitalInspections.org

Based on review of facility policy, medical record review, and interviews, the facility failed to provide an appropriate and ongoing medical screening examination for one (1) patient (#14) of 23 Emergency Department patients reviewed.

The findings include:

Patient #14, a 17-year-old male, arrived at facility A's ED on 8/15/24 at 7:40 PM, via ambulance, after a motor vehicle accident that involved intrusion into the vehicle, requiring extrication of Patient #14 from the vehicle. The patient arrived at the ED complaining of left leg and hip pain and received X-rays of the chest, left femur, and left hip, which did not show any abnormalities. No further testing was completed. The patient was discharged from the hospital 8/15/2024 at 11:50 PM. The following morning, 8/16/2024, the patient developed Hematuria, had increasing pain, and presented to Hospital B where he was found to have multiple Pelvic Fractures and a possible Hematoma or Rupture of the Bladder. The patient was admitted, received therapy, and was discharged 8/19/2024.

Cross Refer to A2406.

Based on review of facility policy, medical record review, emergency department logs, and interviews, the facility failed to provide an appropriate and ongoing medical screening examination for one (1) patient (#14) who presented to the emergency room (ED) following a motor vehicle accident of 23 ED records reviewed.

The findings include:

Review of facility A's policy, "Screening, Transfer, and Acceptance of Patient's with a Possible Emergency Condition (EMTALA)" revised 2/3/2023, showed "Patients...requesting examination and treatment will...receive a Medical Screening Examination by a qualified medical provider...A Medical Screening Examination is defined by policy as...process required to reach with reasonable clinical confidence the point at which it can be determined whether an Emergency Medical Condition exists. Screening is to be conducted to the extent necessary...and is an ongoing evaluation including ancillary services available to the emergency department."

Review of the ED Central Logs showed Patient #14 arrived at the Facility A's ED on 8/15/24 at 7:40 PM, via ambulance, after a motor vehicle accident involving intrusion into the vehicle and required Patient #14 be extricated from the vehicle.

Medical record review of an ED Provider note, dated 8/15/2024 at 7:47 PM, showed Patient #14 complained of left hip and pelvis pain and minimal pain over left bicep laceration. There were 1 cm (centimeter) superficial (existing on the surface) lacerations to left inner upper arm, posterior upper arm, and left upper back. The patient had tender and painful ROM (range of motion) around left hip and pelvis and mild tenderness to left thigh.

Medical record review of ED Provider note, dated 8/15/2024 at 7:54 PM, showed the following orders: Clean off glass, X-ray (XR) chest portable, XR left femur, and XR left hip with pelvis 2 or 3 views.

Medical record review of XR of left pelvis, hip, and femur completed 8/15/2024 at 8:52 PM, showed "impression" was possible foreign body at the left inguinal (groin) region.

Medical record review showed on 8/15/2024 at 10:59 PM, Physician #1 considered inpatient admission versus discharge with close outpatient follow up. He stated the patient's ED workup is "...without major, life threatening abnormalities requiring admission." The patient "doing well" and he felt the "risk of acute decompensation is low" and stated "discharge is reasonable...The patient is comfortable with his pain, x-rays are ok, and no traumatic processes is found."

Medical record review showed no urinalysis or CT (Computed Tomography) imagining of abdomen or pelvis were performed during the patient's admission.

Medical record review showed Patient #14 was discharged from the ED at 11:50 PM.

Medical record review of the discharge summary from Hospital B, dated 8/19/2024 at 10:12 AM, revealed Patient #14 presented on 8/16/2024 with Hematuria and worsening abdominal pain. CT of chest, abdomen, pelvis, thoracic and lumbar spine showed "...thickened heterogeneous material anterior to the urinary bladder involving the space of Retzius (space located in front of the pubic symphysis) [joint that joins the left and right pelvis] and anterior to the urinary bladder...concerning for hematoma (abnormal pooling of blood under the skin) and/or extraperitoneal bladder rupture...Multiple pelvic fractures involving the bilateral pubic bones, dislocation of the pubis symphysis and with a 1 cm fragment displaced posteriorly/internally." X-rays of pelvis showed a "4 mm vertical displacement of the left pubic bone on the left leg weight bearing view suggesting instability of the pubic symphysis. Known pelvic fractures are better appreciated on same day CT." CT cystogram (contrast dye placed in the bladder and a CT scan to detect potential leaks) showed "no evidence of bladder injury...Pubic symphysis injury with symphysis disruption and associated tiny avulsive fractures from the medial pubic bones...1 cm fracture fragment from the right posterior public bone is embedded in the obturator internus muscle [muscle of the hip joint]...Equivocal nondisplaced right anterior sacral fracture..." Continued review of the discharge summary revealed a urinalysis with a small amount of blood (reference = negative). Urology was consulted and a urinary catheter was placed.

During an interview on 11/13/2024 at 9:15 AM, with Physician #1, he stated Patient #14 did have pain and difficulty getting up, but did better after pain medications. He did not remember if he assisted the patient with ambulation. The physician stated "patient did not have fractures identified" when he reviewed the x-rays with the Radiologist. He stated based on the injury and patient's complaints, he would first order X-rays. If there was any indication there was a fracture, he would order a CT scan.