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Based on record review, staff interview and observation, privacy was not provided to patients evaluated in the Emergency Department (ED), under Section 12 Order for Involuntary Psychiatric Admission and ordered for close observation for two of two patients in December 2009 and June 2010 respectively.

The findings are as follow:

Patient A, was evaluated in the ED after self-inflicting multiple lacerations to the left wrist on 12/03/09 at 12:45 AM. The Patient was initially evaluated in Room 15 for both the medical screening and and the psychiatric triage and assessment.

On 12/03/09 at 11 AM, the Patient was moved out of the examining room and placed into the hallway. The ED staff said the hallway was designated as Room 15.5.

Interviews with the Mental Health Technician on 06/10/10 at 8 AM ED Technician (#1 and #2) on 06/10/10 at 1:10 PM and Registered Nurse #2 on 06/10/10 at 9:20 AM said the Observer Sitters were responsible for watching up to three patients at risk in the ED.

The ED Patient Care Director was interviewed during the course of the survey. The ED Patient Care Director said the two areas in the hallway were designated as Rooms 15.5 and 16.5 for patients requiring close observation. There was no provision for privacy provided in the hallway. The designated rooms were beds placed in the open corridor.

A tour of the ED on 06/10/10 at 1:20 PM indicated Patient (B) identified as suicidal and in need of alcohol detoxification was observed in the hallway designated as Room 15.5 in the medical record. There was an assigned one to one sitter/observer assigned to the Patient who was stationed adjacent the nurses station.

The ED staff failed to provide privacy and a safe environment for two of two Patient's (A and B) identified as at risk for harm to self and others.

Based on record review, physician and staff interview, the clinical social worker failed to follow the Hospital's Policy for Psychiatric Triage for one of one Patient's evaluated in the Emergency Department (ED) in December 2009.

The findings are as follow:

The Patient (A) was evaluated in the ED after self- inflicting multiple lacerations to the left wrist on 12/03/09.

Review of the Patient's ED record indicated the Patient had a timely medical screening. The ED Attending Physician ordered a Section 12 for a psychiatric evaluation.

On 12/03/09 at 4 AM, the Patient had a psychiatric triage assessment by the Clinical Social Worker who determined the Patient required a inpatient psychiatric admission.

Review of the Hospital's Policy for the Management of the Psychiatric Patient indicated the Psychiatric-Triage Clinician was required to validate insurance and interview the patient in the ED. The Psychiatric-Triage Clinician was to contact the psychiatrist on-call and the inpatient Mental Health Unit to arrange for admission.

Review of the Policy for Psychiatric Triage For the Doctor On Call (DOC) indicated the purpose of the policy was to outline the process in attaining appropriate physician consultation. The Policy indicated the Psychiatric Triage Clinician must consult with the DOC when requesting hospital level of care. The Policy indicated the Psychiatric Triage Clinician must contact the DOC for any patient with referring issues of suicide, or self-harm, homicide ideation or harm to others or questions of psychosis.

The Clinical Social Worker failed to follow the Hospital's Policy for notifying the DOC.

The Clinical Social Worker was interviewed on 06/10/10 at 8:55 AM. The Clinical Social Worker said there was no reason to call the psychiatrist and certainly not at 4 AM. The Clinical Social Worker said when calls were placed to the DOC, the call goes to an answering service. The Clinical Social Worker said the psychiatrist does not call back. The Clinical Social Worker said a call might be placed to the psychiatrist; if the patient did not have a psychiatric history or if the patient was not completely crazy or low crazy and there was a question whether not the patient should be discharged from the ED.

The Executive Director for the Psychiatric Service was interviewed in person on 06/09/10 at 1 PM. The Executive Director said psychiatrists were not called. The Executive Director said there was an assumption that the receiving facility will contact the DOC on transfer.

Review of the Hospital's Policy for the Emergency Psychiatric Observation Unit (EPOU) indicated the Unit would be staffed by two staff members at all times and at least one staff person must be Emergency Department oriented. Qualified staff included: ED technicians, registered nurse, mental health technicians, security, sitters and triage clinicians. The EPOU was located adjacent to the triage assessment area, consisting of three patient rooms for evaluation, treatment and observation of stable psychiatric patients and the hallway in EPOU may be used during high census. The EPOU unit also consisted of two staff offices and one large workroom for psychiatric clinicians.

The Hospital eliminated the EPOU Unit for patient assessment approximately three years ago. The Policy last updated on 11/07 which included contacting the emergency psychiatric service was no longer relevant to the Hospital's psychiatric services which was currently provided by ED Psychiatric Triage Clinicians who were employees of the Hospital.

The Chief Psychiatrist was interviewed in person on 06/10/10 at 12:30 PM. The Psychiatrist said the existing policy did not reflect the actual practice. The Psychiatrist said the DOC was called for patient's admitted within the two hospital campus sites for admission nor for outside referrals. The Psychiatrist said the clinicians did not call the hospital's own psychiatrist as there was no value in calling. The Psychiatrist said the clinicians would call if there was a question about diagnosis or for a question of psychosis with self-destructive behavior for a patient with a disposition to return home with outpatient arrangement for services.