HospitalInspections.org

Based on review of medical records, emergency department logs, hospital policies, hospital documentation and interviews, it was determined the hospital failed to maintain a central log on each individual who comes to the emergency department (ED), specifically two patients (Patients #1 and #2) who came to the ED on 2/4/10. Sample size was 21.

Findings include:

The hospital's policy "Admission of Patients to the Emergency Dept." revealed: "Procedure: A. All patients will be evaluated by the triage nurse in conjunction with registration by a Registration Clerk. B. All patients will have the appropriate demographic information obtained by an Emergency Department Registration Clerk."

The hospital policy "Plan for Patient Care and Performance Improvement - Emergency Department" revealed: "7. Utilization Review...iii. The Emergency Department Log shall be maintained and shall contain, but not be limited to the following information relating to the patient. a. Name b. Date c. Time and means of arrival d. Age e. Sex f. Record number, account number g. Nature of complaint...."

The Director of Nursing (DON) was interviewed 2/23/10 at approximately 10:00 a.m., regarding admissions to the emergency department (ED). She stated all patients enter through the main door and are met by a greeter on Monday through Friday from 7:00 a.m. through 10:00 a.m. There is the ED registration clerk available from 6:00 a.m. through 12:00 midnight. The triage nurse greets the patient after that time.

The ED Coordinator/Supervisor and the Admitting Supervisor were interviewed 2/23/10 at 12:30 p.m. The ED Coordinator stated all patients entering the ED are logged into the computer system by the registration clerk. This includes the patient's name and date of birth. The registration clerk also records this information along with the patient's chief complaint on a half sheet of paper and gives it to the triage nurse. The ED Coordinator stated she records all patients names, complaint, date and time of triage and disposition in the ED log. The Admitting Supervisor confirmed the registration clerk always enters in the computer system the name and date of birth for each patient that comes in for ED services.

The DON presented the ED logs for the past six months for review. Patient #1 and #2 were not listed in the log on 2/4/10. There was no evidence these two patients were in the ED at any time.

An Admitting Clerk for the ED that worked on 2/4/10, was interviewed on 2/23/10 at 12:00 noon. She stated all patients are logged into the system and seen by the triage nurse. She stated no one is ever turned away for any reason including the inability to pay. When asked if she recalled two patients that came in on 2/4/10, with the complaint of being in a motor vehicle accident the day before, which occurred out of state, she replied she did remember them. She stated the couple stated they were in an accident but wanted to be sure the hospital would bill the insurance company for the charges. She replied they do not do third party billing and would bill the patient directly and they could submit it to their insurance company. The clerk stated the male patient became upset and insisted on not being directly billed. She called the business office and had the billing representative talk with the patient on the phone. She stated another phone rang and she picked up that call. During that call the patient was observed to yell and curse at the business office clerk, hang up the phone and leave the hospital. She stated prior to the call she informed the patient he could still be seen but he wanted to be sure he wasn't going to be billed directly. She acknowledged the triage nurse was not made aware of the these two patients that presented in the ED for services; she did not put their names in the computer system; and did not keep the half sheet of papers with their names and complaints, as they are not kept as part of the record. There was no record of the patients in the ED on 2/4/10.

The business office clerk was interviewed 2/23/10 at 1:15 p.m., regarding the patient's call. She stated the admitting clerk called and informed her this patient wanted to discuss third party billing. She introduced herself with her name and did not get an opportunity to say anymore to the patient. She stated he screamed and cursed at her and hung up. She had no other interaction with the patient.

Patients #1 and #2 did not have their names and disposition entered into the ED log as required.