HospitalInspections.org

Based on record review and interview, the hospital failed to ensure compliance with 42 CFR 489.24, in 2 of the 7 required areas (A2407- provision of stabilizing treatment and A2409-appropriate transfer).

Findings include:

1) The 6/16/15 record review of 21 (ED) emergency department medical records reveals that 2 of the 21 ED patients (Patient #'s 14 and 18) did not receive stabilizing treatment. The 6/16/15 at 8:30 p.m. interview with Compliance Officer E reveals no additional information. (Reference A 2407)

2) The 6/16/15 record review of 21 (ED) emergency department medical records reveals that in 4 of 21 ED patients (Patient #'s 1, 2, 3 and 9) transferred to another hospital (receiving facility) did not have all available medical records related to the emergency medical condition sent to the receiving facility. The 6/16/15 at 8:30 p.m. interview with Compliance Officer E reveals no additional information. (Reference A 2409)

The 6/16/15 record review of 21 (ED) emergency department medical records reveals that 1 of 21 ED patients (Patient #1) did not have written documentation of physician certification of ED patient transfer that was inclusive the risks and benefits of hospital transfer. The 6/16/15 at 8:30 p.m. interview with Compliance Officer E reveals no additional information. (Reference A 2409)

Based on observations and record review, the hospital failed to ensure that their dedicated ED (Emergency Department) waiting rooms had EMTALA (Emergency Medical Treatment and Labor Act) signage conspicuously posted, in 2 of 2 ED waiting rooms observed (main and overflow).

Findings include:

Observations of the Emergency Department accompanied by Corporate Vice President and General Legal Counsel A, on 6/15/15 at 2:30 p.m. reveals that the large main waiting room and the smaller overflow waiting room have no separate EMTALA signage posted. There was no documented evidence of written materials in either waiting room that would inform patients of their EMTALA rights.

Record review of the Children's Hospital of Wisconsin's policies and procedure legend on 6/15/15 reveals that the hospital's EMTALA policies do not have any information with regard to EMTALA signage posting.

Observational information was shared with A on 6/15/15 at 2:30 p.m., A had no verbal response.

Based on record review and staff interview, the hospital failed to ensure that patients refusing further medical treatment had explanation of benefits of further MSE (medical screening examination) and risks of not continuing examination for possible treatment, and have this information documented in their medical record, in 2 of 21 ED (Emergency Department) records reviewed (Patient #'s 14 and 18).

Findings include:

1) Patient #14, a 4 year old came to the ED accompanied by mother, with complaints of Asthma on 12/15/14 at 1:19 p.m. Patient #14 was triaged as "3-Urgent" and assessed by RN (Registered Nurse) F at 1:23 p.m. On 12/15/14 at 2:41 p.m., RN F documents "Mom wants to go to UCC (Urgent Care Clinic), encouraged to stay". The medical record shows "ED dismissal" at 12/15/14 at 2:53 p.m. Complete review of the medical record for this ED stay reveals no documentation that risks and benefits of a MSE were explained to Patient #14's parent or that written informed refusal was provided to Patient #14's parent to sign.

2) Patient #18, a 4 year old came to the ED accompanied by mother, with complaints of Rash with swollen mouth on 5/26/15 at 3:05 p.m. Patient #18 was triaged and assessed at 3:15 p.m. by RN G. On 5/26/15 at 3:20 p.m., RN G documents "Mother stating to this writer that she needs to leave by 5 p.m. and that she has already called a cab. This writer explained that it was possible for ED evaluation and treatment to extend beyond 5 p.m.. Mother stated " I want to see who represents her". This writer had charge RN speak with mother. Charge RN informed this writer that mother stated she would be leaving with child. Charge RN informed mother to return or call at anytime with any concerns." The medical record shows "ED dismissal" at 3:42 p.m. on 5/26/15. Complete review of the medical record for this ED stay reveals no documentation that risks and benefits of a MSE were explained to Patient #18's parent or that written informed refusal was provided to Patient #14's parent to sign.

During interview with Regulatory Compliance Officer E at 8:30 p.m. on 6/16/15, E stated that records would be reviewed to see if additional information could be found.

Based on record review and staff interview, the hospital failed to ensure that patients refusing further medical treatment had explanation of benefits of further MSE (medical screening examination) and risks of not continuing examination for possible treatment, and have this information documented in their medical record, in 2 of 21 ED (Emergency Department) records reviewed (Patient #'s 14 and 18).

Findings include:

1) Patient #14, a 4 year old came to the ED accompanied by mother, with complaints of Asthma on 12/15/14 at 1:19 p.m. Patient #14 was triaged as "3-Urgent" and assessed by RN (Registered Nurse) F at 1:23 p.m. On 12/15/14 at 2:41 p.m., RN F documents "Mom wants to go to UCC (Urgent Care Clinic), encouraged to stay". The medical record shows "ED dismissal" at 12/15/14 at 2:53 p.m. Complete review of the medical record for this ED stay reveals no documentation that risks and benefits of a MSE were explained to Patient #14's parent or that written informed refusal was provided to Patient #14's parent to sign.

2) Patient #18, a 4 year old came to the ED accompanied by mother, with complaints of Rash with swollen mouth on 5/26/15 at 3:05 p.m. Patient #18 was triaged and assessed at 3:15 p.m. by RN G. On 5/26/15 at 3:20 p.m., RN G documents "Mother stating to this writer that she needs to leave by 5 p.m. and that she has already called a cab. This writer explained that it was possible for ED evaluation and treatment to extend beyond 5 p.m.. Mother stated " I want to see who represents her". This writer had charge RN speak with mother. Charge RN informed this writer that mother stated she would be leaving with child. Charge RN informed mother to return or call at anytime with any concerns." The medical record shows "ED dismissal" at 3:42 p.m. on 5/26/15. Complete review of the medical record for this ED stay reveals no documentation that risks and benefits of a MSE were explained to Patient #18's parent or that written informed refusal was provided to Patient #14's parent to sign.

During interview with Regulatory Compliance Officer E at 8:30 p.m. on 6/16/15, E stated that records would be reviewed to see if additional information could be found.