HospitalInspections.org

Based on a review of eight open and three closed medical records, including two violent restraint records, it was determined physicians failed to complete a face-to-face assessment within one hour of initiation of violent restraints for 2 of 2 patients reviewed.

Patient #9 (Pt# 9) presented after attempted self-harm with suicidal ideation and was taken to the Emergency Department (ED) by law enforcement on an emergency petition. Pt# 9 was placed in the psychiatric area of the ED and became aggressive and attempted to elope after an altercation with family and staff. Pt# 9 was placed in violent 4-point restraints at 0312hr and remained in violent restraints until 0400hr. No evidence of a face-to-face assessment by the ordering physician was found in Pt# 9's medical record.

Patient #10 (Pt# 10) presented to the Emergency Department (ED) by law enforcement on an emergency petition after threats of self-harm and threats to harm others in the community. While in the psychiatric area of the ED, Pt# 10 became combative and required violent restraints due to risk of self-injury and threats to staff in the ED. Pt #10 was placed in violent, 4-point restraints at 1820hr and remained in violent restraints until 2215hr. Review of Pt# 10's medical record revealed no evidence of a face-to-face assessment by the ordering physician as required within one hour of initiation of violent restraints.

Based on a review of eight open and three closed medical records, it was determined the hospital failed to plan for, and provide, care consistent with an Emergency Department (ED) patient's chief complaint and presenting symptoms for 1 of 11 patients reviewed. Patient #11 (Pt# 11) was transported to the hospital ED by ambulance with complaints of chest pain. The hospital ED staff triaged Pt# 11 and assigned an Emergency Severity Index (ESI) score of ESI-2. ESI-2 is defined as "Emergent" with "High risk of deterioration, or signs of a time-critical problem" (Emergency Severity Index Scale ranking - defined via an algorithm and used industry-wide by Emergency Departments - assigns a number based on the patient acuity and anticipated needs). The patient was triaged and vital signs were taken on arrival to the ED at 0654hrs. An electrocardiogram (ECG) was completed by the ED staff shortly after the patient arrived in the ED at 0705hrs that revealed normal sinus rhythm. No evidence was found in the medical record of additional vital signs being measured and documented after the initial reading in triage at 0654hrs or further diagnostic tests. There was no documentation that the patient was reassessed, and either seen by a physician or re- assigned a lower acuity ESI score.
Medical record documentation revealed the patient was not seen in the 4 hours following triage when staff attempted to retrieve the patient from the waiting room and the patient was not present. Record review revealed the patient was documented as "discharged" at 1100hrs.