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Based upon document review and interview the facility did not comply with all the provisions for maintaining a central log. Please reference findings under Tag A 205.

Based on observation, policy review, document review, medical record review and interview, The facility failed to ensure all individuals are entered into the central log upon presentation to the Emergency Department (ED) for 1 of 24 patients. (Patient #1). The current system fails to log in patients upon arrival which could result in a delay in triage, medical screening exam and/or treatment for a medical emergency.

Findings include:

Observation on 05/02/18 at 10:15 AM revealed that when entering the ED waiting room, there is a desk to the left were registration staff are located. There is a desk to the right, where a security guard is stationed. On the security desk, there is a bin holding the Patient Information" slips, which have instructions for patients to complete the information (arrival time, name, date of birth, primary physician and reason for visit) and hand the slip to the security guard or triage nurse. Behind the registration desk, behind a curtain is the triage area.

Review of policy "Patient Transfers: EMTALA/COBRA" effective 09/18/17 indicates it is the responsibility of the hospital to maintain a central log which records each patient who presents for treatment or is transferred to another facility. The log must include: Name, age, gender, date/time/means of arrival or transfer, nature of medical condition/complaint, patient refusal of treatment, hospital inability to treat, disposition and time of departure.

Review of an email/surveillance pictures sent by Staff (B) Director of ED Services revealed a man (allegedly Patient #1) and a woman entered the Mercy Ambulatory Center (MACC) for approximately 9 minutes (11:34 PM to 11:43 PM) on 03/24/18.

Review of the MACC ED Daily Log (central log) dated 03/24/18 and 03/25/18 revealed no evidence Patient #1 presented to the MACC.

Review of the Mercy Hospital ED record (2nd facility Patient #1 presented to) dated 03/25/18 revealed Patient #1 arrived as a walk-in at the facility a 12:00 midnight with a complaint of chest pain. He was triaged as an Acuity 2- Emergent, received a cardiac workup and was admitted for observation at 02:04 AM.

Interview on 05/02/18 at 10:20 AM with Staff (C), Security revealed when a patient enters the waiting room, they come to the security desk, fill out a slip, give it to the security guard, who looks to see what the problem is and then gives it to the triage nurse. They do not enter patient information into the system.

Interview on 05/02/18 from 10:30 to 10:40 AM with Staff (A), Nurse Manager revealed all patients present to the security or registration desk and fill out a Patient Sign In slip. Security or registration staff either give the Patient Sign In slip to the triage nurse assigned to the triage area located behind the registration desk in the waiting room (until 12 midnight) or bring the slip in the back (ED proper) to notify nursing staff that a patient has presented in the waiting room. Patients are entered into the computer system by the triage nurse.

Interview on 05/02/18 at 10:35 AM with Staff (D), Triage Nurse revealed security will tell her if there is a patient who needs to be seen right away, otherwise the slips are placed in a bin located on the security guard desk. When they are busy, Staff (D) looks at the slips to determine who is to be seen first.

Interview on 05/02/18 at 02:15 PM with Staff (J), Triage Nurse revealed that if a patient leaves before triage, they are not entered into the central log. On 03/24/18 Staff (L), Registration Clerk came into the back (ED proper) indicating there was a chest pain patient (Patient #1) in the waiting room. Staff (J) walked out to the waiting room, approached the couple (Patient #1 and a woman) and said "I'm the triage nurse. I have one thing to do and will be right back." The woman asked for Staff (J)'s name and then the couple left. Patient #1 signed a Patient Information slip, but there is no time (or date) on it. Patient #1 was not triaged so he was not entered into the central log.

Interview on 05/02/18 at 03:15 PM with Staff (L), Registration Clerk, revealed patients are not entered into the computer prior to triage. Security does not enter information into the computer. On 03/24/18 a couple came in. Staff (L) went to the back (ED proper) to get the triage nurse. The triage nurse came out to the waiting area, told the couple she was dealing with a critical patient in the back and would be back out when she was done. The triage nurse left and came back a couple minutes later, but the couple were already gone.

Interview on 05/03/18 at 10:10 AM with Staff (A), Nurse Manager and Staff (N), Quality Assurance confirmed that Patient #1 was not entered into the ED central log and no medical record was generated because he left before triage. Patient Information slips used when a patient presents to the ED are not routinely kept on file and are not part of the permanent record or ED central log. The slips do not have the visit date or the name of the person accepting the slips. The arrival time entered in the electronic medical record (EMR) is the time the nurse starts to enter the patient information during triage, and not necessarily when the patient arrived at the facility.