HospitalInspections.org

Based on record review, staff interview, and review of the facility's policies/procedures the facility failed to ensure that emergency services were integrated with other departments of the hospital.

Findings:

1. The facility failed to ensure that the Nuclear Medicine Department was integrated with the Emergency Department. The technician for the Nuclear Medicine department failed to respond timely to a request for a STAT Nuclear Medicine study to be performed on Sample patient #2.

a. Policies/Procedure Review
A review of the facility's policy, "Provisions for 'On Call' Exams" revealed:
"After normal business hours technologists are on call for Nuclear Medicine...Upon notification of procedure required the on call technologist will be paged and/or called by the Imaging Department Staff...
The technologist on call must respond to the page within 10 minutes. They must arrive at the facility to perform the procedure within 45 minutes at all campuses."

b. Medical Record Review
A review of Sample patient #2's record revealed that the patient presented to the facility's Emergency Department with a complaint of shortness of breath on 03/05/12 at 3:39 p.m. The physician's assistant ordered a nuclear medicine study "STAT" at 5:37 p.m. A nursing notation at 5:44 p.m. stated that the patient was waiting for the nuclear medicine study to be performed. A notation from the nurse at 7:45 p.m. stated that the patient was informed that the facility was awaiting the nuclear medicine study to be performed. The patient left against medical advice at 9:20 p.m. after being informed that the department was awaiting the nuclear medicine technologist.

c. Facility Document Review
A review of the time clock entry in the presence of the facility's Compliance Manager revealed that the nuclear medicine technologist arrived at the facility at 9:00 p.m. The facility did not maintain documentation of when the technologist had been called by either the radiology department or the emergency department.

d. Staff Interview
An interview with the facility's Compliance Manger conducted on 06/28/12 at 9:22 a.m. revealed that the Nuclear Medicine department closed at 4:30 p.m. each day. S/he stated that the person entering the order for a nuclear medicine study would need to call the main radiology department to have the technologist called. A subsequent interview on 06/28/12 at 12:06 p.m. revealed that the Nuclear Medicine department did not keep any type of log to track when technicians were called or responded to pages. S/he stated that the technician had clocked in at 9:00 p.m. and had checked the computer order at 9:41 p.m. A subsequent interview on 06/28/12 at 1:59 p.m. revealed that after s/he had a discussion with the Director of the Radiology department was that there was no documentation or indication that the radiology department was aware of the issue with the delayed response of the Nuclear Medicine technician. S/he stated that no changes had been made as the department was not aware of any issue.

Based on record review, staff interview, and review of the facility's policies/procedures the facility failed to ensure that emergency services were integrated with other departments of the hospital.

Findings:

1. The facility failed to ensure that the Nuclear Medicine Department was integrated with the Emergency Department. The technician for the Nuclear Medicine department failed to respond timely to a request for a STAT Nuclear Medicine study to be performed on Sample patient #2.

a. Policies/Procedure Review
A review of the facility's policy, "Provisions for 'On Call' Exams" revealed:
"After normal business hours technologists are on call for Nuclear Medicine...Upon notification of procedure required the on call technologist will be paged and/or called by the Imaging Department Staff...
The technologist on call must respond to the page within 10 minutes. They must arrive at the facility to perform the procedure within 45 minutes at all campuses."

b. Medical Record Review
A review of Sample patient #2's record revealed that the patient presented to the facility's Emergency Department with a complaint of shortness of breath on 03/05/12 at 3:39 p.m. The physician's assistant ordered a nuclear medicine study "STAT" at 5:37 p.m. A nursing notation at 5:44 p.m. stated that the patient was waiting for the nuclear medicine study to be performed. A notation from the nurse at 7:45 p.m. stated that the patient was informed that the facility was awaiting the nuclear medicine study to be performed. The patient left against medical advice at 9:20 p.m. after being informed that the department was awaiting the nuclear medicine technologist.

c. Facility Document Review
A review of the time clock entry in the presence of the facility's Compliance Manager revealed that the nuclear medicine technologist arrived at the facility at 9:00 p.m. The facility did not maintain documentation of when the technologist had been called by either the radiology department or the emergency department.

d. Staff Interview
An interview with the facility's Compliance Manger conducted on 06/28/12 at 9:22 a.m. revealed that the Nuclear Medicine department closed at 4:30 p.m. each day. S/he stated that the person entering the order for a nuclear medicine study would need to call the main radiology department to have the technologist called. A subsequent interview on 06/28/12 at 12:06 p.m. revealed that the Nuclear Medicine department did not keep any type of log to track when technicians were called or responded to pages. S/he stated that the technician had clocked in at 9:00 p.m. and had checked the computer order at 9:41 p.m. A subsequent interview on 06/28/12 at 1:59 p.m. revealed that after s/he had a discussion with the Director of the Radiology department was that there was no documentation or indication that the radiology department was aware of the issue with the delayed response of the Nuclear Medicine technician. S/he stated that no changes had been made as the department was not aware of any issue.