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Based on interview, record review, and observation, the facility failed to maintain a central log on each individual who comes to the emergency department, as defined in §489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged when, Patient #1 was not recorded as having been in the facility's emergency department, seeking care for a medical emergency and the facility did not record and capture all patients leaving before an emergency screening examination.

Findings:


During a telephone interview, on the afternoon of 12/15/24, Patient #1's mother stated, "I took Patient #1 to the emergency room, we always go to this hospital. I tried to check her in; the person at the desk kept asking me for my daughter's social security (SS) number and ID (identification). I asked him what would he do if they didn't have a SS number, or if they were from another country? He answered by asking for the SS and ID. I told him to look her up by her name, again he asked for the SS and ID. I told him he was denying care and left."
When asked if Staff #7, Paramedic, recently had a patient leave because they didn't have the SS or ID, Staff#7 stated, "I remember, it was a mother and her daughter. I asked for the SS. She (mother) gave me her (patient) name. She (mother) said why can't you just register her? I asked if she(mother) had her birthdate. She(she) told me she had the SS number; she gave me eleven numbers. I told her it had eleven numbers. We just went back and forth. I was trying to find a way to register her. We (the facility) can't give service without registering them." When asked if Staff# had reported the patient leaving, Staff#7 stated, "I told the charge nurse, he just shook his head."
During an interview on 12/17/24 at 9:30 am, in an administrative office, when asked about the missing patient on the emergency room log, Staff #8, Chief Nursing Officer confirmed the patient was not on the log. When asked how and where the facility recorded patients that had left the emergency room, Staff #8 stated, "If a patient came in and wasn't registered, they wouldn't be on the log."

Based on record review, and interview, the facility failed to provide a reasonable registration process when a patient was discouraged from remaining for a medical emergency screening evaluation. Patient #1 was repeatedly asked for a social security number and identification; preventing her from being registered and advancing to triage and receiving a medical screening examination.

Findings:

Review of the facility provided Emergency Department Triage Guidelines (dated 12/21) reflected, "Triage is performed by a qualified RN at the time of presentation and may be done in concert with a quick registration ...C. All patients presenting to the emergency room are triaged (assessed) to determine the chief complaint and assign acuity. The acuity determines the time to treatment goals and the amount of time the patient can safely wait to be seen by a physician when no beds or caregivers are immediately available."

During a telephone interview, on the afternoon of 12/15/24, Patient #1's mother stated, "I took Patient #1 to the emergency room, we always go to this hospital. I tried to check her in; the person at the desk kept asking me for my daughter's social security (SS) number and ID (identification). I asked him what would he do if they didn't have a SS number, or if they were from another country? He answered by asking for the SS and ID. I told him to look her up by her name, again he asked for the SS and ID. I told him he was denying care and left."

During a telephone interview, on the afternoon of 12/16/24, in an administrative conference room, Staff # 7, paramedic when asked how he registers patients into the emergency department stated, "I ask them if they have been here before. I get their SS and ID; I have to go to a different screen if this is their first time here. We can also use their name and date of birth."
When asked if Staff #7, Paramedic, recently had a patient leave because they didn't have the SS or ID, Staff#7 stated, "I remember, it was a mother and her daughter. I asked for the SS. She (mother) gave me her (patient) name. She (mother) said why can't you just register her? I asked if she(mother) had her birthdate. She(she) told me she had the SS number; she gave me eleven numbers. I told her it had eleven numbers. We just went back and forth. I was trying to find a way to register her. We (the facility) can't give service without registering them." When asked if Staff#7 had reported the patient leaving, Staff#7 stated, "I told the charge nurse, he just shook his head."

During an interview on the morning of 12/16/24, in an administrative conference room, when asked about the facility's policy for registering patients in the facility's emergency room, Staff #3, Quality Director stated, "We don't have a policy for the registering of patients. The registering is not part of triage."

During an interview on the morning of 12/17/24, in an administrative conference room, when asked who received the training on triaging patients, Staff #2, ED Nurse manager stated, "The nurses get training on triage. Triage is the initial nursing assessment to find out why the patient is here and to decide if they need to go back immediately. The paramedics and techs do not, they will register the patients and the nurse will do the triage." When asked if the patient is unable or refuses to give the number and ID how does the staff handle the situation? "We wouldn't have had a system on how to handle this type of situation. Now, we are prepared for it. We had a meeting last night and decided to use the down time forms to get the patient triaged; registration can get them registered, after the medical screening examination.
We get the social security number and ID so we can find them (the patient) in the electronic records, it gives the providers access to a patient's previous admissions, medical history, and medications."