HospitalInspections.org

Based on interview and record review the Hospital failed to provide an appropriate medical screening examination for 1 of 25 medical records reviewed. A patient with stroke symptoms waited over 16 hours in the emergency room for a medical screening examination. (Patient ID# 1)

Finding include:

Medical record review of the nursing triage notes for patient ID# 1 revealed this was a 64-year-old woman that presented to the emergency room on 11/25/12 at 7:24 p.m. with complaints of "Pain to left shoulder and loosing balance and unable to hold stuff in the right hand". The patient was classified as level "3" or "urgent" by the triage nurse using an Emergency Severity Index of 1 to 5. The patient's blood pressure at the time of triage was 171/99. Past Medical History listed "Diabetes and Hypertension".

After presenting to the emergency room on 11/25/12 at 7:24 p.m., the patient had to wait 16 hours and 17 minutes until she was seen by a physician for a Medical Screening Examination.

A Medical Screening Examination (MSE) was performed on 11/26/12 at 11:41 a.m. by a physician. The MSE stated "64 year-old with past medical history of hypertension, diabetes, presenting with right sided weakness for the past 1 week. After the weakness began on Saturday it progressively worsened, leading to the patient to drop objects and prompting the ED visit. While in the ED waiting room she noted an acute decrease in her ambulatory capacity around 11:00 p.m. She was given a wheelchair as a result. Will order CT Head Stat to rule out Cerebral Vascular Accident (CVA). Patient presenting with symptoms concerning for ischemic CVA, outside the window." A Cat Scan of the head was done and it showed an "ischemic stroke in the anterior cerebral artery".

According to the Medical Screening Examination, Patient ID# 1's condition changed around 11:00 p.m. on 11/25/12 but the triage nurse failed to notify the physician of a change in condition and failed to re-classify the patient as "emergent". The patient was subsequently admitted to the hospital. A Discharge Summary dated 12/6/12 stated "Diagnoses: Diabetes, Hypertension, Cerebral Vascular Accident. Discharged to skilled nursing facility."

Interview 1/14/13 at 11:30 a.m. with the Emergency Department Nursing Director (ID# 3) revealed the hospital is fully aware of the case regarding patient ID# 1. The Nursing Director stated that with the History and age of the patient and the symptoms it should have prompted an "immediate response" from the staff for a Medical Screening Examination.

Record review of a policy regarding "EMTALA" dated 12/6/12 stated "Medical Screening Examination: The process required to reach, with reasonable clinical confidence, the point at which it can be determined whether the individual has an Emergency Medical Condition or not. A Medical Screening Examination is not an isolated event. It is an ongoing process that begins, but typically does not end, with triage."

Based on interview and record review the Hospital failed to provide an appropriate medical screening examination for 1 of 25 medical records reviewed. A patient with stroke symptoms waited over 16 hours in the emergency room for a medical screening examination. (Patient ID# 1)

Finding include:

Medical record review of the nursing triage notes for patient ID# 1 revealed this was a 64-year-old woman that presented to the emergency room on 11/25/12 at 7:24 p.m. with complaints of "Pain to left shoulder and loosing balance and unable to hold stuff in the right hand". The patient was classified as level "3" or "urgent" by the triage nurse using an Emergency Severity Index of 1 to 5. The patient's blood pressure at the time of triage was 171/99. Past Medical History listed "Diabetes and Hypertension".

After presenting to the emergency room on 11/25/12 at 7:24 p.m., the patient had to wait 16 hours and 17 minutes until she was seen by a physician for a Medical Screening Examination.

A Medical Screening Examination (MSE) was performed on 11/26/12 at 11:41 a.m. by a physician. The MSE stated "64 year-old with past medical history of hypertension, diabetes, presenting with right sided weakness for the past 1 week. After the weakness began on Saturday it progressively worsened, leading to the patient to drop objects and prompting the ED visit. While in the ED waiting room she noted an acute decrease in her ambulatory capacity around 11:00 p.m. She was given a wheelchair as a result. Will order CT Head Stat to rule out Cerebral Vascular Accident (CVA). Patient presenting with symptoms concerning for ischemic CVA, outside the window." A Cat Scan of the head was done and it showed an "ischemic stroke in the anterior cerebral artery".

According to the Medical Screening Examination, Patient ID# 1's condition changed around 11:00 p.m. on 11/25/12 but the triage nurse failed to notify the physician of a change in condition and failed to re-classify the patient as "emergent". The patient was subsequently admitted to the hospital. A Discharge Summary dated 12/6/12 stated "Diagnoses: Diabetes, Hypertension, Cerebral Vascular Accident. Discharged to skilled nursing facility."

Interview 1/14/13 at 11:30 a.m. with the Emergency Department Nursing Director (ID# 3) revealed the hospital is fully aware of the case regarding patient ID# 1. The Nursing Director stated that with the History and age of the patient and the symptoms it should have prompted an "immediate response" from the staff for a Medical Screening Examination.

Record review of a policy regarding "EMTALA" dated 12/6/12 stated "Medical Screening Examination: The process required to reach, with reasonable clinical confidence, the point at which it can be determined whether the individual has an Emergency Medical Condition or not. A Medical Screening Examination is not an isolated event. It is an ongoing process that begins, but typically does not end, with triage."