HospitalInspections.org

Based on findings from interview and document review, the facility did not ensure that all individuals presenting to the Emergency Department (ED) or other areas (obstetrical (OB) unit) are entered into a central log. The lack of a central log in the OB unit does not ensure care provided to these individuals can be tracked.

Findings include:

-- Per interview of Staff C, ED Nurse Manager on 10/18/16 at 10:50 am, patients presenting to the ED, who are 20 weeks gestation or greater, are triaged by a registered nurse (RN) and if stable are directed to the OB unit for a medical screening exam (MSE). The triage nurse completes the form titled "OB Patient Triage Record" and faxes it to the OB unit. These patients are not entered into the ED Central Log.

-- Per interview of Staff H, Charge Nurse OB unit on 10/18/16 at 1:30 pm, patients presenting to the ED who are greater than 20 weeks gestation are transported to the OB Unit for a MSE. The OB unit does not maintain a central log of OB patients transported from the ED for MSE.

-- Review of facilities policies and procedures (P&P) did not provide evidence that the facilty had established P&P on a process for OB unit staff to maintain a central log of these patients.

-- During interview with Staff A, Director of Quality/Case Management on 10/18/16 at 1:45 pm, he/she acknowledged the above findings.

Based on findings from observation, interview and document review, the facility did not have an adequate process to facilitate patient triage in the Emergency Department (ED). This could lead to potential patient harm.

Findings include:

-- During tour of the ED on 10/18/19 at 9:55 am, multiple patients were observed standing in one line waiting to be registered at one of three registration stations. Registration included registering for lab work, imaging studies, ambulatory surgery check-in, cardiology visits and emergency room visits. Signage indicated "Registration" above the three registration stations. There was no signage indicating or directing patients to ED registration.

-- Per interview of Staff D, Registration Clerk on 10/18/16 at 10:00 am, he/she asks a patient if they are here for an emergency room visit or surgical visit at the time of registration. He/she completes a "short form" registration for emergency room patients and notifies the ED nurse via computer. The patient is then directed to the waiting room.

-- During interview of Staff F, ED Charge Nurse on 10/18/16 at 11:45 am, he/she explained that if a patient presents to registration with chest pain, shortness of breath or stroke symptoms, the registration clerk calls into the ED.

-- During interview of Staff E, Patient Access Director on 10/18/16 at 10:15 am, he/she indicated that patients presenting for ED services, surgical visits, imaging studies, cardiology visits and lab work register at one of the three registration stations. The ED does not have a dedicated registration clerk.

-- Review of a Registration log dated 10/19/16 revealed the following:

7:00 am-11:00 am
-15 patients registered for ED services
-66 patients registered for laboratory and/or imaging services
-4 patients registered for same day surgery

All these patients waited in the same registration line.

-- Per interview of Staff C, ED Nurse Manager on 10/19/16 at 9:00 am, there is poor signage in the ED waiting area to direct ED patients. There have been discussions with Administration for options to decrease the traffic congestion at registration, e.g., a separate waiting area for ED patients and limiting the number of outpatient labs drawn at the hospital, however, nothing has been implemented.

-- Review of the facility's Department of Emergency Medicine meeting minutes, dated 7/14/15, revealed renovations in the ED and lobby would begin October/November 2015. However, meeting minutes dated 10/13/15, revealed renovations to the lobby/registration/ED had been put on hold. Meeting minutes dated 4/12/16, revealed the plan to expand the triage area would be re-addressed.

-- During interview of Staff A, Director of Quality/Case Management on 10/19/16 at 5:00 pm, he/she acknowledged the above findings.