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A2406 Medical Screening Exam (MSE): The hospital failed to provide a Medical Screening Examination (MSE) to a patient who was taken to the Emergency Department by ambulance (Patient #3).



Hospital policy titled "EMTALA-Medical Screening Examination and Stabilization Treatment" revealed: "...When an EMS provider brings an individual to the Hospital with a Dedicated Emergency Department and the Hospital does not have the capacity or capability to provide an immediate medical screening exam and if needed, stabilizing or an appropriate transfer, the Hospital must still assess the individual upon arrival to ensure that the individual is appropriately prioritized based on presenting signs and symptoms. Hospital should assess whether the EMS can appropriately monitor the individual ' s condition...."

1 of 1 patients did not receive an appropriate MSE upon arrival at the facility and there was no record that the patient was assessed and monitored according to the facilities policy.

Based on review of policies and procedures, hospital documents and staff interviews, it was determined that the hospital failed to provide a Medical Screening Examination to a patient who presented to the ED via Emergency Medical Services (EMS) ambulance for examination and treatment (Patient #3).

Findings include:

Patient #3 presented to Banner Baywood Medical Center (BBMC) Emergency Department (ED) from a care facility via Emergency Medical Services (EMS) ambulance on 05/25/2022 at 17:32. Patient #3 was transported to the ED for shortness of breath and hypoxia. Patient #3 arrived to the ED via EMS on 6 liters of oxygen with an oxygen saturation of 96% and was alert and talking. EMS waited with Patient #3 in corridor until a room became available. At 18:15 when Patient #3's room became available, Patient #3 suffered a respiratory arrest and a CODE BLUE was initiated. Patient #3 was revived and subsequently admitted to the Intensive Care Unit (ICU).

Hospital policy titled "Emergency Department Patient Care" revealed: "...Triage assessment: Completed by a RN and/or QMP (qualified medical professional). If a paramedic is used to expedite triage to assist with high volume, the RN oversees the ESI scoring, care plan of the patient and utilizes standing orders when needed. An Emergency Severity Index (ESI) score is assigned when the triage assessment is completed. ESI 1= Requires immediate life-saving interventions ...ESI 2= High risk situation or confused, lethargic, disoriented or severe pain distress ...ESI 3= two or more resources may be needed...ESI 4=One or more resource may be needed ...ESI 5+ No resources needed ...ED triage documentation may include, but is not limited to: 1. Chief complaint, vital signs, paint ad oxygenation. 2. Mode of arrival and mechanism of injury. 3. Triage assessment and ESI scoring. 4. Infectious disease screening. 5. Suicide screening...Medical Screening Exam: A medical screening exam (MSE) is completed by an Emergency Physician or QMP...When applicable the ED medical provider and/or QMP will complete the MSE in conjunction with an RN or Paramedic as a joint assessment...General Nursing Care: Patients arriving from all portals of entry into the ED will receive a baseline assessment of their chief complaint by a registered nurse, physician or designee...."

Hospital policy titled "EMTALA-Medical Screening Examination and Stabilization Treatment" revealed: "...When an EMS provider brings an individual to the Hospital with a Dedicated Emergency Department and the Hospital does not have the capacity or capability to provide an immediate medical screening exam and if needed, stabilizing or an appropriate transfer, the Hospital must still assess the individual upon arrival to ensure that the individual is appropriately prioritized based on presenting signs and symptoms. Hospital should assess whether the EMS can appropriately monitor the individual ' s condition...."

A review of the ED disposition log for 05/25/2022 revealed the patient was registered at 17:32.

A review of the ED census on 05/25/2022 for the timeframe Patient #3 was in the ED revealed 50 patients were in rooms, with 19 patients being held for transfers to the inpatient units; 4 other EMS patients were waiting for rooms in the corridor and 14 patients were in the lobby.

A review of the Patch prehospital call form dated 05/25/2022 at 1724 revealed ETA 10 minutes, from care home, hypoxia 80% on O2. Vitals: BP 101/67, HR 135, RR 8, O2 6 liters 96% sat, temp 99.3. Assigned room 62 when clean.

Emergency Medical Services (EMS) medical record revealed " ... dispatched for Patient #3 with chief complaint of shortness of breath and hypoxia which has become worse in last hour. Upon arrival to patient's care home, patient was alert with no obvious life-threatening signs or symptoms. Interventions: Oxygen at 6 liters per minute via facemask which maintains SPO2 above 93%. Cardiac monitoring/12 lead EKG: sinus tach. Status and monitoring during transport: patient's vitals and condition was monitored every 5-15 minutes throughout the transport. No further changes occurred in the patient ' s condition. No further interventions were done. Patch to medical direction: N/A. Upon arrival to the ED we had a delay in getting a bed. Patient's room was not ready and we were advised we would have to wait until the patient in room 62 was discharged and the room was cleaned. Patient had a GCS of 14 upon arrival with O2 sat of 93% on O2. Patient became increasingly lethargic in the last 5 minutes of waiting and we tried to check the status of the room. We also had trouble getting a last blood pressure as the patient was taking off equipment and moving excessively. As we arrived into room 62 the patient was no longer responding to verbal or physical stimuli and we advised the ED staff patient's condition had deteriorated and they should get the crash cart. Care and report was transferred to the RN and physician. Patient was transferred to bed 62 in unstable condition and a GCS of 7.... "

A review of Patient #3 medical record revealed a face sheet identifying Patient #3 was registered at 17:30 on 05/25/2022. Patient #3 had a respiratory arrest at 18:18 while being transferred to a room in the ED. An MSE was documented as being completed at 18:18 at the time of the CODE BLUE. Nursing triage was completed at 19:00. Patient was transferred to an inpatient unit at 00:27 on 05/26/2022.

Employee #4 confirmed during an interview conducted on 08/4/2022 that facility policy was not followed as Patient #3 did not receive triage or an MSE until Patient #3's room became available 48 minutes after presenting to the ED.