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Due to the nature of the deficiencies, the facility failed to comply with the Condition of Governing Body. The governing body of the hospital failed to ensure that conditions and environment in the Emergency Department protected the privacy and dignity of patients and ensured the safety of patients, visitors and staff in the department.

The facility failed to meet the following standard under the Condition of Governing Body:

A 092 Governing Body - Emergency Services
The governing body failed to ensure that the facility was in compliance with the Condition of Participation of Emergency Services.

The governing body failed to ensure that the facility was in compliance with the following Conditions of Participation and Standards under those Conditions:

A 115 Condition of Patient Rights
The hospital failed to protect the personal privacy and safety of their patients.

A 0142 Patient Rights - Privacy and Safety
The facility failed to maintain an environment that ensured patient privacy and safety in the Emergency Department.

A 143 - Patient Rights - Personal Privacy
The facility failed to ensure that the privacy of patients receiving care in the Emergency Department was protected.

A 144 - Patient Rights- Care in a Safe Setting
The facility failed to ensure the safety of patients, visitors and staff in the Emergency Department, by allowing hallway beds and equipment to obstruct the emergency suite corridors and egress corridors, preventing rapid and safe evacuation of the department in the event of an emergency.

A 700 - Condition of Physical Environment
The hospital failed to ensure that the facilities were adequate to ensure that patients received treatment in an environment that was large enough and adequately equipped to deliver private, dignified and safe care to patients.

A 725 - Physical Environment - Complexity of Facilities
The facility failed to ensure that physical facilities and equipment utilized to provide emergency services in the hospital were adequate to meet the needs of the volume of patients being cared for in the emergency department. The severely overcrowded conditions in the emergency department, which led to the wide-spread and ongoing use of hall beds for patients in emergency suite corridors and egress hallways of the department, created a situation in which patient privacy and dignity and safe evacuation in an emergency for patients, visitors and staff was compromised.

A 1100 Condition of Emergency Services
The facility failed to ensure that patients received treatment in an environment that was large enough to deliver private, dignified and safe patient care.

Based on tours/observations, staff and patient interviews and review of facility documents, the governing body failed to ensure that the facility was in compliance with the Condition of Participation of Emergency Services.

Findings:

Refer to Tag A 1100 - Condition of Participation of Emergency Services for findings related to the patient care environment in the Emergency Department that caused the facility to be out of compliance with the Condition of Emergency Services.

Due to the nature of the deficiency, the hospital failed to comply with the Condition of Patient Rights. The hospital failed to protect the personal privacy and safety of their patients.

The facility failed to meet the following standard under the Condition of Patient Rights:

A 0142 Patient Rights - Privacy and Safety
The facility failed to maintain an environment that ensured patient privacy and safety in the Emergency Department.

A 143 - Patient Rights - Personal Privacy
The facility failed to ensure that the privacy of patients receiving care in the Emergency Department was protected.

A 144 - Patient Rights- Care in a Safe Setting
The facility failed to ensure the safety of patients, visitors and staff in the Emergency Department, by allowing hallway beds and equipment to obstruct the emergency suite corridors and egress corridors, preventing rapid and safe evacuation of the department in the event of an emergency.

Based on tours/observations, staff and patient interviews and review of facility documents, the hospital failed to maintain an environment that ensured patient privacy and safety in the Emergency Department. The failure created the potential for negative patient outcomes.

Findings:

Refer to Tag A 143 - Patient Rights - Personal Privacy for findings related to the facility failure to ensure that the privacy of patients receiving care in the Emergency Department was protected.

Refer to Tag A 144 - Patient Rights- Care in a Safe Setting for findings related to the facility failure to ensure the safety of patients, visitors and staff in the Emergency Department, by allowing hallway beds and equipment to obstruct the emergency suite corridors and egress corridors, preventing rapid and safe evacuation of the area in the event of an emergency.

Based on tours/observations, interviews and review of documentation, the facility failed to ensure patients, placed in hallway beds in the emergency department suite and egress corridors, the right to personal privacy during personal hygiene activities, during medical /nursing treatments and when providing personal information.

Findings:
1. A tour of the Emergency Department (ED) was conducted on 1/17/13 at approximately 2:00 p.m. and on 1/18/13 at approximately 1:30 p.m. The ED was frequently on ambulance divert but walk in patients still presented to the ED to be seen.
The ED presently has 40 patient rooms and was divided into zones, green, red, yellow and white. Hallway beds were located within these zones. Some of the hallway beds had permanent signs above the bed on the wall, while other hallway beds had no signs to identify the number of the hallway bed. Patients observed in the hallway beds either awaiting care or admitted as inpatients awaiting a bed on an inpatient unit. The ED rooms had patients awaiting treatment or the patients had been admitted and were awaiting a bed on an inpatient unit. When an ED "inpatient" was transferred to an inpatient unit within the hospital, a hallway bed patient was moved into the ED "inpatient" room.
Some of the hallway beds were observed to have had "privacy" screens that partially concealed the patient, and some beds had "mayo" stands provided for patient use for water and/or meals. This did not apply to all hallway beds. Per staff interview, patients in the hallway beds were given "dinger" bells to call for assistance. Per staff interview, there was 1 bathroom on each side of the zones and a commode was possible for a patient room. Laboratory drawing of blood and electrocardiograms (EKGs) were also performed on hallway bed patients.

a. On 1/17/13, an ED patient was observed lying on a bed in the hallway holding an emesis bag to his/her face with no privacy for vomiting. There was no privacy curtain for this patient.
b. On 1/17/13, ED patient was observed with a c-collar and wrist brace, the patient was not ambulatory and had no call light or other observable mechanism to call for help or toileting. One visitors chair was positioned at the end of the patient's bed in the hallway, directly in the line of traffic and continually bumped by traffic coming around the corner.
c. Some patient hallway beds were placed "head to head" to address privacy issues when the patient was being examined or receiving treatments.
d. A patient in a hallway bed was observed receiving a nebulizer treatment.

Interviews:
a. On 1/18/13, at approximately 1:45 p.m., a patient was observed receiving intravenous (IV) fluids while in a hallway bed. An interview with a family member noted the patient presented to the ED at 11:00 a.m. and was placed in a hallway bed at approximately 12:00 p.m. They were awaiting laboratory results.
b. Another patient interview was conducted at approximately 1:45 p.m. The patient presented to the ED with upper chest pain and was placed in the hallway bed at approximately 10:30 a.m. S/he stated s/he was seen earlier by a physician assistant (PA), had an EKG (in the hallway bed) and had xrays performed. S/he was awaiting test results. When asked how s/he would summon staff if needed s/he stated s/he would call out and stop someone. Although the patient was in street clothes, no privacy screen was observed around the hallway bed or observed in the hallway.

The ED hallways were congested with beds and equipment, noise level was high, lighting bright and patients in hallway beds had little privacy including confidentiality when discussing health issues with ED staff, including nursing, physicians or admission personnel. There was no way to ensure that patient privacy was protected when personal information such as name, age, address, income, insurance information was provided to hospital staff during the course of treatment.

Facility documentation reviewed, determined the facility had been using hallway beds at least, since March of 2012.

Reference tags:

Refer to Tag A 144 - Patient Rights- Care in a Safe Setting for findings related to the facility failure to ensure the safety of patients, visitors and staff in the Emergency Department, by allowing hallway beds and equipment to obstruct the emergency suite corridors and egress corridors, preventing rapid and safe evacuation of the area in the event of an emergency.

A 700 - Condition of Physical Environment
The hospital failed to ensure that the facilities were adequate to ensure that patients received treatment in an environment that was large enough and adequately equipped to deliver private, dignified and safe care to patients.

A 725 - Physical Environment - Complexity of Facilities
The facility failed to ensure that physical facilities and equipment utilized to provide emergency services in the hospital were adequate to meet the needs of the volume of patients being cared for in the emergency department. The severely overcrowded conditions in the emergency department, which led to the wide-spread and ongoing use of hall beds for patients in emergency suite corridors and egress hallways of the department, created a situation in which patient privacy and dignity and safe evacuation in an emergency for patients, visitors and staff was compromised.

A 1100 Condition of Emergency Services
The facility failed to ensure that patients received treatment in an environment that was large enough to deliver private, dignified and safe patient care.

Based on tours/observations, interviews and facility documentation the facility failure to ensure the safety of patients, visitors and staff in the Emergency Department, by allowing hallway beds and equipment to obstruct the emergency suite corridors and egress corridors, preventing rapid and safe evacuation of the area in the event of an emergency.

Findings:
1. A tour of the Emergency Department (ED) was conducted on 1/17/13 at approximately 2:00 p.m. and on 1/18/13 at approximately 1:30 p.m. The ED was frequently on ambulance divert but walk in patients still presented to the ED to be seen.
The ED presently had 40 patient rooms and was divided into zones, green, red, yellow and white. Hallway beds were located within these zones. Some of the hallway beds had permanent signs above the bed on the wall, while other hallway beds had no signs to identify the number of the hallway bed. Patients observed in the hallway beds either awaiting care or admitted as inpatients awaiting a bed on an inpatient unit. The ED rooms have patients awaiting treatment or the patients have been admitted and were awaiting a bed on an inpatient unit. When an ED "inpatient" was transferred to an inpatient unit within the hospital, a hallway bed patient was moved into the ED "inpatient" room.

a. Per staff interview, as there was no call light system for hallway bed patients, they were given "dinger" bells to call staff for assistance. Not all patients in the hallway beds were observed to have bells.

b. The hallways were congested with the hallway beds, equipment required to provide care to the patients in these beds, visitors and facility staff members. Family members sitting at the patient bedside increased the congestion in the hallways. The ED hallway noise level was high and lighting bright, not conducive to providing care and treatment for some patients emergency conditions.

c. On 1/17/13, an interview was conducted with the ED director. S/he stated that recently, in the last few months, a detox patient was in a hallway bed. The patient became overstimulated and agitated. Staff was unable to de-escalate the patient, security was notified and the patient was "tased".

d. On March 2012, a female patient in a hallway bed, reported when she went to get a cup of coffee, she left her purse on the bed. When she returned her purse was missing. Her purse was later found in a trash can but her money was missing.

The concurrently conducted CMS Life Safety Code Survey, completed on 02/04/13, identified the following unsafe conditions for patients, visitors and staff in the Emergency Department:
1. Corridors were obstructed by patient hall beds in the Emergency Department suite corridors, creating unsafe egress in the event of an emergency evacuation.
2. Egress corridors were obstructed by patient care hall beds and equipment, creating unsafe egress in the event of an emergency evacuation.
3. Patient hall beds were found not to have the required four electrical outlets (2 regular outlets and 2 emergency outlets) as required to accommodate patient medical support equipment, as required.

Reference tags:

Refer to Tag A 143 - Patient Rights - Personal Privacy for findings related to the facility failure to ensure that the privacy of patients receiving care in the Emergency Department was protected.

A 700 - Condition of Physical Environment
The hospital failed to ensure that the facilities were adequate to ensure that patients received treatment in an environment that was large enough and adequately equipped to deliver private, dignified and safe care to patients.

A 725 - Physical Environment - Complexity of Facilities
The facility failed to ensure that physical facilities and equipment utilized to provide emergency services in the hospital were adequate to meet the needs of the volume of patients being cared for in the emergency department. The severely overcrowded conditions in the emergency department, which led to the wide-spread and ongoing use of hall beds for patients in emergency suite corridors and egress hallways of the department, created a situation in which patient privacy and dignity and safe evacuation in an emergency for patients, visitors and staff was compromised.

A 1100 Condition of Emergency Services
The facility failed to ensure that patients received treatment in an environment that was large enough to deliver private, dignified and safe patient care.

Due to the nature of the deficiency, the hospital failed to comply with the Condition of Physical Environment. The hospital failed to ensure that the facilities were adequate to ensure that patients received treatment in an environment that was large enough and adequately equipped to deliver private, dignified and safe care to patients.

The facility failed to meet the following standard under the Condition of Physical Environment:

A 725 - Physical Environment - Complexity of Facilities
The facility failed to ensure that physical facilities and equipment utilized to provide emergency services in the hospital were adequate to meet the needs of the volume of patients being cared for in the emergency department. The severely overcrowded conditions in the emergency department, which led to the wide-spread and ongoing use of hall beds for patients in emergency suite corridors and egress hallways of the department, created a situation in which patient privacy and dignity and safe evacuation in an emergency for patients, visitors and staff was compromised.

Based on tours/observations, staff interviews and review of facility documents, the hospital failed to ensure that physical facilities and equipment utilized to provide emergency services in the hospital were adequate to meet the needs of the volume of patients being cared for in the emergency department. The severely overcrowded conditions in the emergency department, which led to the wide-spread and ongoing use of hall beds for patients in emergency suite corridors and egress hallways of the department, created a situation in which patient privacy and dignity and safe evacuation in an emergency for patients, visitors and staff was compromised. The failures created the potential for negative patient, visitor and staff outcomes.

Findings:

Refer to Tag A 143 - Patient Rights - Personal Privacy for findings related to the facility failure to ensure that the privacy of patients, receiving care in the Emergency Department, was protected.

Refer to Tag A 144 - Patient Rights- Care in a Safe Setting for findings related to the facility failure to ensure the safety of patients, visitors and staff in the Emergency Department, by allowing hallway beds and equipment to obstruct the emergency suite corridors and egress corridors, preventing rapid and safe evacuation of the area in the event of an emergency.

Refer to Tag A 1100 - Condition of Emergency Services for findings related to the facility failure to ensure that patients received treatment in an environment that was large enough to deliver private, dignified and safe patient care.


Reference the findings in the concurrently conducted CMS Life Safety Code Survey, completed on 02/04/13, which identified the following unsafe conditions for patients, visitors and staff in the Emergency Department:
1. Corridors were obstructed by patient hall beds in the Emergency Department suite corridors, creating unsafe egress in the event of an emergency evacuation.
2. Egress corridors were obstructed by patient care hall beds and equipment, creating unsafe egress in the event of an emergency evacuation.
3. Patient hall beds were found not to have the required 4 electrical outlets (2 regular outlets and 2 emergency outlets) as required to accommodate patient medical support equipment, as required.

Based on the manner and degree of deficiencies cited the facility failed to be in compliance with the Condition of Participation of Emergency Services. The Facility failed to meet the needs of patients in accordance with acceptable standards of practice.

FINDINGS:
Based on observation and interview the Facility failed to ensure that patients received treatment in an environment that was large enough to deliver private, dignified and safe patient care.

During a tour of the Emergency Department (ED) on 01/17/13 at 2:00p.m., the ED suite was severely overcrowded. The ED has separated areas referred to as "zones", red, yellow, green and white. The ED suite had 40 permanent rooms, in addition, there were 21 beds aligned along the walls in different hallways.

The Facility had arranged beds in corridors and identified the spaces with names, "radiology hallway", "pharmacy hallway" and "Chartreuse hallway". There was a 15 bed "inpatient" holding in the "yellow zone". Some of the hallway beds were identified by number on plaques above the bed, some beds had no identifiers. All beds were occupied with patients.

The "radiology hallway" was an egress between the inpatient pavilion and the outpatient pavilion. There were 10 beds observed against the wall during the tour. Four of the beds were occupied with patients. There were no bed identifiers or privacy screens. There were no call lights and it is unclear how patients would call for help or assistance as the "radiology hallway" is separated from the ED by a wall of windows and a double automatic closing double door. There were no toileting facilities in or near this area. There were no tables to accommodate food and water and no patients were observed to have food or water. There was no emergency equipment observed in the area.

Outside of the trauma room, there was an area called "DSR" where there were four beds, two directly inside of the ambulance entrance against the wall, and two along a short corridor leading to the "radiology hallway." These four beds are separated from the "radiology hallway" by automatic closing double doors and separated from the ED suite on the other side by automatic closing double doors. Inside of the short corridor alongside the beds is an office style area with Xerox paper, printer and computer. In one of the DSR hallway beds a patient was receiving a nebulizer treatment.

There were no toileting facilities in or near the "DSR" area, patients needing toileting would have to be able to ambulate to the inside of the ED suite to the bathroom. There were no call lights in this area. There were no bedside tables to accommodate food or water and no patient was observed to have food or water. There was no emergency equipment in this area.

The ED suite was filled to capacity with visitors, students, care providers, ambulance traffic, and housekeepers. There was a high level of noise and stimulation. The beds in the hallways inside the ED suite were not provided with screens for privacy and there was no privacy available for discussion personal health information as there was a constant flow of people around the patients. There were limited toileting facilities inside of the ED suite for patients, and for staff toileting facilities were located outside of the ED suite.

One patient lying on a bed in the hallway was holding an emesis bag to her face with no privacy for vomiting. Another patient was observed with a c-collar and wrist brace, the patient was not ambulatory and had no call light or other observable mechanism to call for help or toileting. One visitor's chair was positioned at the end of the patient's bed in the hallway, directly in the line of traffic and continually bumped by traffic coming around the corner.There were no call lights associated with the hall beds in the ED suite, no privacy screens, no tables to accommodate food or water. No patients in the hallway beds were observed to have food or water.

The "Chartreuse hallway", located inside of the ED suite, had 5 identified beds along the walls with space for other beds that the ED manager stated would be used for patients. The "Pharmacy hallway", located in the ED suite down from the pharmacy, had four beds labled A, B, C and D. There were no call lights associated with these beds. There were one privacy screen observed. There were no tables to accommodate food or water and no patients were observed to have any food or water. There were no toileting facilities near this hallway. There was no emergency equipment in the "Pharmacy hallway".

Throughout the ED suit unused equipment, makeshift workstations and chairs cluttered the hallways with one chair observed to block an exit door.

Reference tags:

Refer to Tag A 143 - Patient Rights - Personal Privacy for findings related to the facility failure to ensure that the privacy of patients receiving care in the Emergency Department was protected.

Refer to Tag A 144 - Patient Rights- Care in a Safe Setting for findings related to the facility failure to ensure the safety of patients, visitors and staff in the Emergency Department, by allowing hallway beds and equipment to obstruct the emergency suite corridors and egress corridors, preventing rapid and safe evacuation of the area in the event of an emergency.

A 700 - Condition of Physical Environment
The hospital failed to ensure that the facilities were adequate to ensure that patients received treatment in an environment that was large enough and adequately equipped to deliver private, dignified and safe care to patients.

A 725 - Physical Environment - Complexity of Facilities
The facility failed to ensure that physical facilities and equipment utilized to provide emergency services in the hospital were adequate to meet the needs of the volume of patients being cared for in the emergency department. The severely overcrowded conditions in the emergency department, which led to the wide-spread and ongoing use of hall beds for patients in emergency suite corridors and egress hallways of the department, created a situation in which patient privacy and dignity and safe evacuation in an emergency for patients, visitors and staff was compromised.