HospitalInspections.org

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure an Emergency Department patient with an Emergency Severity Index level two was reassessed within one hour and care was provided in a timely manner for one of one medical record reviewed (MR1).

Findings:

Review on December 19, 2023, of the facility policy, "Triage," last reviewed December 2022 revealed "I. Purpose: To identify and prioritize the patient's needs for care and treatment. To ensure timely treatment based on presentation at time of triage, and when deemed appropriate by the triage nurse. II. Policy: A. Patients arriving in the Emergency Department are triaged. A Registered Nurse is assigned to cover the triage area 24 hours a day, seven days a week. Patients are triaged in the triage area or at the bedside in the main Emergency Department depending on patient volume and severity of illness or injury. ... III. Definitions: Triage - process that involves the rapid sorting of patients who present to the emergency department (ED) to distinguish those who need immediate medical attention from patient who can safely wait to be seen. Emergency Severity Index(ESI)- is a five-level emergency department (ED) triage algorithm that provides clinically relevant stratification of patients into five groups from 1. (most urgent) to 5 (least urgent) on the basis of acuity and resource needs ... VI. Procedure: A. Plan: 1. Triage is the process of sorting and classifying patients into priorities of treatment through rapid patient assessment. It is most valuable at times when the number of patients exceeds the number of caregivers or available beds. 2. In some types of patients, early therapeutics and diagnostics may be implemented through the Initial Triage Assessment Guidelines to expedite care. ... C. Operation 1. Triage Nurse ... b. Responsibilities and duties: i. Assess patient upon arrival and determine the urgency of care needed using rapid triage assessment and designate appropriate care area. ... v. Observe for changes in condition of waiting room patients, reassess/reprioritize as necessary. Reassessment recommendation of acuity level 2 should not exceed one hour and level 3 two hours. ... D. ESI Levels ... b. Level 2: Care required as soon as possible; condition presents danger if not treated; "acute" but not severe. ..."

Review on December 19, 2023, of MR1 revealed the patient presented to the ED on October 29, 2023, at 2102 via personal vehicle for groin pain. There was documentation MR1's triage was started at 2105. There was triage nursing documentation MR1 presented to the hospital for a right upper groin hernia. There was documentation MR1 had a history of hypertension for 10 years but was medication noncompliant. There was triage nursing documentation MR1's blood pressure was 216/117 at triage. There was documentation MR1 was assigned an Emergency Severity Index (ESI) level of 2. There was documentation at 2111 MR1's triage was complete and MR1 was assigned to the waiting room.

Continued review of MR1 revealed there was no documentation MR1's blood pressure was reassessed during the ED visit. There was documentation MR1 expressed to the triage nurse frustration with the ED wait time at 2357. There was documentation MR1 left the ED without being seen on October 30, 2023, at 0030.

Interview on December 19, 2023, with EMP1, at approximately 1330, confirmed the findings noted above for MR1. EMP1 confirmed MR1 did not receive any treatment for the elevated blood pressure and MR1's blood pressure was not reassessed throughout the ED visit. EMP1 confirmed MR1 left without being seen on October 30, 2023, at approximately 0030.