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Based upon medical record review, document review and interview, the facility did not comply with all the provisions for conducting a medical screening exam.

Please reference findings under Tag A 2406.

Based on document review, medical record review and interview the hospital did not provide a medical screening exam (MSE) for 1 of 26 patients who presented to the Emergency Department (Patient #1). A lack of a MSE could result in an emergency medical condition not being identified and treated.

Findings include:

Review of Patient #1's ED medical record dated 01/25/19 revealed at 11:31 AM she presented and was registered for a chief complaint of mental health evaluation. At 11:52 Patient #1 is documented as left without being seen and discharged from the ED at 11:53AM. There is no evidence of documentation that Patient #1 was triaged.

Interview on 02/07/18 at 11:30AM with Staff (F), Registered Nurse (RN) Psychiatric ED, revealed that she noticed Patient #1 was in ED by the electronic board. She went out to talk to Patient #1 and her mother at registration. Patient #1's mother was looking for somewhere to go that had adolescent psychiatric services so her daughter could be evaluated upon recommendation by her school. Staff (F) stated that she talked to Patient #1's mother who was aware of the services that the hospital provides, as she has a relative that is employed there. Staff (F) stated that Patient #1 was calm, did not have suicidal thoughts and was just depressed. Patient #1's mother did not have funds for transportation, and was given a cab voucher so they could go to another facility. Staff (F) further stated that Patient #1 and her mother left the ED from waiting room and that she did not document any of this information in Patient #1's medical record.
Staff (F) stated that she was trained that anytime she saw a child/adolescent on the board for a psychiatric/mental health exam and/or if she is requested by the Medical ED staff, she goes out to the lobby and explains that the facility does not have inpatient adolescent behavioral health services and that children/adolescents would have to be transferred. Staff (F) stated that she would also explain the process and that the parent would have to stay with the child/adolescent while they are examined and transferred and that this can be a lengthy process.

Interview on 02/08/19 at 09:25AM with Staff (O), ED Registration Clerk, revealed she remembered Patient #1 coming into ED with her mother. Staff (O) stated Patient #1's mother told her that her daughter was having suicidal thoughts. Staff (O) stated Patient #1's mother was looking for transportation and was already aware that they did not have adolescent psychiatric services at the facility and her daughter would ultimately need to be transferred. Staff (O) stated a nurse came out and talked with Patient #1 and her mother, they were given a cab voucher, and a cab was called so they could be taken to another facility.
Staff (O) stated when an adolescent psychiatric patient comes in she tells them that they don't have adolescent psychiatric services here, they can be taken back for assessment and would be transferred to another facility. Staff (O) stated that a nurse will come out to talk with the patient and explain this process as well.

Review on 02/08/19 of the "Rules and Regulations of the Medical and Dental Staff", last revised 01/31/19 indicates that medical screening examinations are performed to determine whether an emergency medical condition exists. If a decision to transfer is made, the hospital must, prior to transfer, provide whatever medical treatment it can, within its capacity, to minimize the risks to the individual with an unstable medical condition.

Review on 02/08/19 of policy #A-28, "Screening, Stabilization and Transfer of Patients Pursuant to the Emergency Medical Treatment and Active Labor Act of 1986" last revised 12/2018, indicates that patients presenting to the Emergency Department and who request examination or treatment or has such a request made on his or her behalf, or if a prudent layperson observer would believe that an individual needs examination or treatment for a medical condition, will be evaluated, treated and transferred when appropriate. A medical screening examination must be provided to all patients who present to the hospital's emergency department.

Review on 02/08/19 of policy "Triage: ED-31" last revised 01/2016 revealed triage will be performed upon arrival. The registered Nurse will evaluate and categorize each patient upon arrival to the Emergency Department.

Review on 02/08/19 of policy "Medical Clearance of a child or adolescent presenting to the Psychiatric Emergency Department: ED-48," last revised 02/2019 revealed, given the absence of child/inpatient psychiatric services at Niagara Falls Memorial Medical Center, if the patient requires admission, transfer to another facility is required. The arrangements for transfer can only be initiated after the medical clearance is completed; therefore, timely nursing assessment and medical clearance is essential.

Review on 02/08/19 of policy "Child/Adolescent Assessment Procedure: H-11" last revised 01/2019 revealed upon arrival, child or adolescent patients seeking or appearing to be in need of behavioral health services will be triaged in the ED by the triage nurse. The triage nurse will then walk the patient to the locked Psychiatric ED door, accompany patient into the Psych ED and provide a verbal report to the Psychiatric nurse. The Psychiatric nurse will notify the ED medical staff for medical clearance. A comprehensive behavioral health Assessment including Mental Status Exam, Lethality Assessment and Drug and Alcohol Screen will be completed by the Psychiatric ED nurse.

Review on 02/08/19 of policy "Elopement of Psychiatric Patient from Emergency Room: H-2," last revised 10/2017 revealed all patients who have requested psychiatric services but leave premises prior to Medical Staff's disposition decision, shall be considered elopement. Complete documentation of the course of events is to be made in the chart including time of elopement, who was notified, condition of patient prior to leaving including patient behavior and any other pertinent and reflective information.