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Based on staff interview, record review, and facility policy review the facility failed to provide an appropriate medical screening exam (MSE) for one (1) of 20 patients reviewed during last 6 months: Patient #16.

Findings Include:

Cross Refer to A2406 for the facility's failure to provide an appropriate medical screening exam (MSE) for patients #16 within the capability of the hospital Emergency Department.

During exit conference on 10/13/2022 at 12:15 p.m. with Chief Nursing Officer, Director of Accreditation, Corporate Compliance Officer and Vice President, survey findings were discussed and no further documentation was submitted for review.

Based on staff interview, record review, Medical Staff Bylaws, and facility policy review, the facility's Emergency Department (ED) failed to provide an appropriate Medical Screening Exam (MSE) for one (1) of 20 patients reviewed: Patient #16

Findings Include:

Interview with Director of Nursing for Emergency Department (ED), on 10/12/2022 at 11:00 a.m. revealed the facility had a nurse practitioner regularly scheduled to work in ED and provide medical screen exams (MSE) which helped with the wait time for MSE.

Interview with the Director of the Emergency Department on 10/12/2022 at 11:00 a.m. reveals it is expected patients waiting will be re-assessed after triage even if they are in the waiting room.

Interview with Director of Accreditation, on 10/12/2022 at 11:11 a.m. revealed the facility administration is aware that not scheduling a nurse practitioner to work in the ED is causing a delay in medical screening examinations.

Review of the medical record Triage Assessment and Triage Notes for Patient #16 (age 5) dated 08/16/2022 revealed the patient presented to the Emergency Department (ED) on 8/16/2022 at 10:43 a.m. with complaints of asthma flare up. Triage was completed at 11:05 a.m. with an Emergency Severity Index (ESI) Level three (3) acuity level assigned. Pulse level 138, Respirations 30, Blood pressure 142/83, Oxygen saturation level 92%. Medical record reveals no documented evidence of re-assessment between triage time at 11:05 a.m. and discharge (left without being seen) at 3:23 p.m.

Review of the Discharge Information on 08/16/2022 in Patient #16 medical record revealed the patient was not seen by provider for a MSE and left without being seen at 3:23 p.m., after a four and a half (4 1/2) hour wait in the ED waiting area.

Review of the facility's EMTALA policy, dated 03/2022, revealed " ...If an individual comes to the Emergency Department ...The Hospital should provide for an appropriate medical screening examination ... including ancillary services routinely available ... to determine whether an emergency medical condition exists ...".

Review of policy and procedure; "Triage assessment," dated 06/2011, last revised date 09/2019, states " ...H. All patients in the waiting room should be reassessed to include vital signs and pain assessments with time frame appropriate to their ESI triage level, but no longer than every 2 hours ... 1. C. ESI Level 3: Vital signs no less frequently than every two (2) hours ..."

Review of facility's Bylaws, Rules and Regulations of the Medical Staff, dated May 22, 2021, " ...Emergency services shall be provided ...Every individual ...requesting examination or treatment will receive and appropriate medical screening examination ...to determine if an emergency medical condition exists ...".

During exit conference on 10/13/2022 at 12:15 p.m. with Chief Nursing Officer, Director of Accreditation, Corporate Compliance Officer, and Vice President, survey findings were discussed and no further documentation was submitted for review.