HospitalInspections.org

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Based on document review, video review, interview and in one (1) of four (4) Medical Records reviewed, the facility failed to provide an appropriate Medical Screening Examination (MSE) to determine if an Emergency Medical Condition (EMC) existed.

This lack of an MSE may have placed patients at an increased safety risk.

Findings include:

The facility's security video of the Emergency Room (ER), dated 09/06/18, from 6:40PM to 7:25PM identified the following:

*6:40:35PM - Patient #1 entered the Registration Room from the Waiting Room, passed two (2) Security Guards, and bypassed the Triage Room.

*6:41:13PM - Patient #1 exited the Registration Room, entered the ER, and walked towards the Staff Lounge. Patient remained in the Staff Lounge for approximately forty (40) minutes.

*7:20:05PM - Patient #1 then exited the Staff Lounge with Staff H (Access Service Representative {ASR}) and walked to the Nurses' Station.

*7:21:24PM - Staff K (ASR) was observed with Patient #1. Staff K walked to the printer, retrieved labels, then returned to the desk and placed an identification (ID) band on Patient #1. At this time, Staff H walked through the Triage Room to the Security Desk, picked up a pad, brought it into the Triage Room and handed it to Staff G (Registered Nurse {RN}), and was observed talking to Staff G and Staff J (RN).

*7:22:00PM to 7:22:39PM - Staff H was observed talking to Staff F (Physician).

*7:22:41PM - Patient #1 and Staff K joined Staff Members H and F at the Nurses' Station and appeared to have a conversation.

*7:22:48PM - Staff I (RN) is observed standing behind the Doctor.

*7:23:54PM - Patient #1 is observed making a phone call on her cell phone.

*7:24:02PM - Staff F picked up the phone and Staff I walked away.

*7:24:25PM - Patient #1 walked out of the Emergency Department (ED).
As per video review, the patient presented to the ED, was registered, spoke with a Physician and staff, then exited the ED approximately three (3) minutes later.

Review of Patient #1's Medical Record identified that on 09/06/18 at 7:31PM, a 31-year-old female presented to the Emergency Room, was registered, then left prior to triage at 7:33PM. The Triage Note stated, "The patient no longer wanted to be seen in this hospital". Total visit time was two (2) minutes. No documentation indicating the patient was offered an MSE or refused care/treatment was found.

Per interview of Staff F on 09/25/18 at approximately 11:30AM, Staff F stated that on 09/06/18, she was at the end of her shift, sitting at the Nursing Station, completing work. Staff F was approached by a Registrar/Secretary and asked if she would perform an ultrasound on a patient. Staff F stated she knew Patient #1, since Patient #1 is an employee. She asked Patient #1 what was wrong. Patient #1 complained she was having belly pain and asked if Staff F would perform an ultrasound "off the record". Staff F stated she encouraged Patient #1 to "get registered" and to be evaluated by a Doctor. Staff F then answered a phone call and did not realize Patient #1 had left. When asked why she didn't document this conversation in the Medical Record, Staff F stated, "she wasn't my patient, so there's no reason why I would have documented on her".

Per interview of Staff G (Triage RN) on 09/25/18 at 1:15PM, Staff G confirmed she was working in Triage on 09/06/18, when she was approached by the patient's co-worker, Staff H.

Staff H informed Staff G that the patient "needs to be seen". Staff G stated to Staff H that "We don't have labor and delivery here, ... there was no reason the patient couldn't be seen ... but I just wanted her to know that this is not a labor and delivery hospital". Staff G suggested the patient speak to the Doctor to determine what would be the best route for the patient.

Staff G stated, "I know [Patient #1] is pregnant, but I never spoke to the patient. I didn't get any paperwork on the patient ... the patient went directly to the Secretary, and never came to Triage ... They [patient and co-worker] spoke to the Doctor and she [Patient #1] left." When asked why she didn't engage the patient, Staff G replied, "The patient was already talking to the Doctor".

Per interview of Staff I (RN) on 09/25/18 between 2:00PM and 3:00PM, Staff I stated that on 09/06/18, "When I walked over to the Nursing Station to tell [Staff F] something, I overheard the conversation and Staff F encouraged the patient to stay and be seen ... the Secretaries were trying to talk her out of driving herself to LIJ (Long Island Jewish). I asked her why doesn't she stay? The patient refused and stated that she wanted to go to LIJ or Manhasset."

Per interview of Staff H (Access Service Representative) on 09/26/18 at 1:40PM, Staff H stated that on 09/06/18, "I mentioned to Staff G (Triage RN) that Patient #1 wasn't feeling good, that she's having stomach pains and is really upset. Staff G stated, "I don't know what we will be able to do for her here. Maybe you should speak to one of the Doctors." Then I went to speak to Staff F. I explained the situation to Staff F and she then called the patient over to speak to her. I left her (Patient #1) at the Nursing Station while I was having the conversation with the Triage Nurse. I didn't hear the conversation between the patient and the Doctor. She (Patient #1) was crying. I was trying to stop her and tell her it was not good for her to drive in that condition."

The facility could not provide documented evidence that Patient #1 had received a Medical Screening Examination or refused a Medical Screening Examination when offered.