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Based on review of facility policy, review of Emergency Medical Services (EMS) Prehospital Care Reports, review of an EMS audio recording, review of the Emergency Department (ED) central log, medical record review, and interview, the facility failed to provide a Medical Screening Exam (MSE) for 1 patient (Patient #1), and failed to prevent a delay in treatment for 1 patient (Patient #1) for 30 ED patients reviewed.

The findings include:

Refer to A-2406.

Based on review of facility policy, review of Emergency Medical Services (EMS) Prehospital Care Reports, review of the Emergency Department (ED) central log, and interview, the facility failed to ensure 1 patient (Patient #1), who presented to the ED via EMS for dialysis, was listed on the ED central log of 30 patients sampled.

The findings include:

Review of Facility A's policy titled Emergency Medical Treatment and Active Labor ACT (EMTALA) Guidelines, last revised 12/2019, showed "...An individual in a ground or air ambulance...on hospital property for presentation for examination and treatment for a medical condition at a hospital's dedicated emergency department is considered to have come to the emergency department...Hospital property...entire main hospital campus, including the parking lot, sidewalk, and driveway and other physical areas immediately adjacent to the Hospital's main buildings...Central Log: All patients presenting to the Emergency Department (ED) requesting evaluation and treatment will be logged in the ED log..."

Review of an EMS Prehospital Care Report dated 12/8/2020 showed EMS transported Patient #1 from Facility B to Facility A's ED on 12/8/2020 for dialysis and "...upon arrival...patient [Patient #1] remained on stretcher in the ambulance until patient dialysis appointment was confirmed...per [facility] patient was not confirmed to have dialysis appointment was was told [by ED staff] they [unknown] would need to schedule appointment with hospital..." Patient #1 was transported back to Facility B.

Review of Facility A's ED central log showed Patient #1 was not listed on the log dated 12/8/2020.

During an interview on 12/16/2020 at 4:00 PM, the ED Manager at Facility A confirmed Patient #1 was transported to the ED on 12/8/2020 by EMS for dialysis but remained in the ambulance in the ambulance bay.

During a telephone interview on 12/17/2020 at 9:10 AM, Registered Nurse (RN) #1 at Facility B stated Patient #1 was transferred to Facility A's ED on 12/8/2020 for a dialysis treatment to prevent symptoms from lack of dialysis because the patient did not received outpatient dialysis on 12/7/2020 related to a positive test for COVID-19.

During an interview on 12/17/2020 at 11:55 AM, the Education Coordinator at Facility A confirmed Patient #1 was not listed on the ED Central Log dated 12/8/2020.

Based on review of facility policy, medical record review, review of an Emergency Medical Services (EMS) Prehospital Care Report, and interview, the facility failed to ensure a medical screening exam (MSE) was completed for 1 patient (Patient #1) who presented to the Emergency Department (ED) via EMS for dialysis of 30 ED patients sampled.

The findings include:

Review of Facility A's policy titled Emergency Medical Treatment and Active Labor ACT (EMTALA) Guidelines, last revised 12/2019, showed "...Triage-refers to the clinical assessment of the individual's presenting signs and symptoms at the time of arrival at the hospital in order to prioritize when the individual will be seen by a physician or other qualified medical personnel (QMP) for completion of the Medical Screening Examination...A Medical Screening Examinations (MSE) will be performed for any individual that: presents on hospital property and requests examination or requires treatment for what may be an emergency medical condition; has such a request for examination or treatment made on his or her behalf..."

Medical record review for Patient #1 from Facility B showed the patient was admitted on 11/24/2020 with diagnoses including End Stage Renal Disease, Dependence on Renal Dialysis, Hypothyroidism, and Hypertension. The patient received dialysis every Monday, Wednesday, and Friday. Patient #1 was diagnosed with COVID-19 on 12/6/2020. Continued review showed Patient #1 was unable to have his regularly scheduled dialysis appointment on 12/7/2020 because he tested positive for COVID-19. The dialysis clinic advised Facility B to transfer Patient #1 to the ED for dialysis on 12/7/2020 or 12/8/2020.

Review of an EMS Prehospital Care Report dated 12/8/2020 showed EMS transported Patient #1 from Facility B to Facility A's ED on 12/8/2020 for dialysis. Upon arrival to the ED, Patient #1 remained in the ambulance while EMS staff confirmed Patient #1's dialysis appointment with Facility A. The facility informed EMS that Patient #1 did not have a dialysis appointment and would need to schedule an appointment for dialysis. Patient #1 was transported back to Facility B.

During an interview on 12/16/2020 at 4:00 PM, the ED Nurse Manager stated Patient #1 was transported to the ED on 12/8/2020 by EMS for dialysis. The ED Nurse Manager confirmed Patient #1 did not receive a MSE on 12/8/2020.

During a telephone interview on 12/17/2020 at 9:10 AM, Registered Nurse (RN) #1 at Facility B, stated Patient #1's last dialysis treatment was on 12/4/2020 and arrangements had been made for his dialysis at a dialysis clinic providing treatment for patients with COVID-19, but the county EMS could not transport outside of the county so a secondary ambulance service was contacted, but they had no availability. Patient #1 was then transferred to Facility A's ED on 12/8/2020 for dialysis to prevent symptoms from lack of dialysis. RN #1 stated the ED Supervisor at Facility A called her and stated they were refusing Patient #1 for outpatient dialysis because the patient did not have any signs or symptoms of fluid overload and Facility B needed to set up outpatient dialysis for the patient. RN #1 stated on 12/9/2020 Patient #1 "...went unconscious..." and was transported to Facility A's ED and had not returned to Facility B.

During an interview on 12/17/2020 at 11:15 AM, the Chief Nursing Officer confirmed Patient #1 was not triaged and did not receive a MSE by a Qualified Medical Provider (QMP).

During a telephone interview on 12/17/2020 at 5:15 PM, Emergency Medical Technician (EMT) #1 confirmed no one from the ED assessed the patient and the patient was transported back to Facility B without receiving dialysis.

During a telephone interview on 12/17/2020 at 5:25 PM, EMT #2 confirmed no one from the ED assessed the patient and the patient was transported back to Facility B without being seen by a physician.

During a telephone interview on 12/21/2020 at 11:55 AM, Physician #2 stated after patients were assessed by an ED physician and lab values were obtained, the ED physician will make the determination whether to discharge a patient or to admit for dialysis.