HospitalInspections.org

16790

.
Based on interviews, the review of medical records and other documents, it was determined that the facility did not consistently inform each patient, or when appropriate, the patient's representative, of his or her rights in advance of furnishing or discontinuing patient care. This deficiency was noted in eight (8) of twelve (12) applicable medical records reviewed (MRs #5, #6, #7, #8, #9, #10, #15 & #16)

Findings include:

The review of MR #5 on 6/28/11 at approximately 10:25AM during the tour of Unit N 71/73 noted that this 71-year-old male with past history of HTN, DM & CAD was admitted to vascular surgery service on 6/14/11 and was discharged on 6/27/11. It was noted that a copy of a Notice of Discharge & Appeal Rights was signed by the patient dated 6/27/11. However, a copy of "An important Message from Medicare" (IM) form was not located in the record. The nursing staff interviewed on 6/28/11 at 12:35PM reported that Patients' Rights information is provided on admission and reinforced in the unit. This staff also reported that Patient Advocates distribute the Patients' Rights documents on the unit. The staff had no explanation why an IM was not provided to this patient as required.

Review of MR #6, on 6/28/11 at 11:30AM, noted that this patient, a 75-year-old nursing home resident, with history of HTN and Dementia was sent to the hospital for evaluation on 6/23/11. Although an IM notice dated 6/23/11 was noted in the record, it was documented on the form "unable to sign-heavily medicated." The record revealed several encounters with the patient's family. The patient ' niece was her surrogate; the patient's daughter consented for diagnostic procedures and in addition, the MD spoke to the daughter regarding reversing the DNR/DNI. However, there was no evidence that Patients' Rights information was discussed with the patient's representative and a copy of the Important Message from Medicare was given or sent to the patient's representatives.

During the tour of Unit N62 on 6/28/11 at 2:45PM, a folded copy of the Important Message from Medicare was noted on the patient's bed in Room 633. At interview with the patient she reported that the form was just given to her to read by a staff. The patient did not recall the name of the staff.

The review of MR #7 on 6/26/11 at approximately 3:30PM noted that this 71-year-old patient was admitted on 6/15/11 with complaint of shortness of breath. The patient signed the General Consent form on 6/15/11. However, the IM form located in the record was dated 6/28/11. The facility did not meet regulatory requirement of furnishing Medicare Beneficiaries with the "Important Message from Medicare" notice within two (2) days of admission.

Review of MR #8, on 6/28/11 at approximately 3:00PM, noted that this 92-year-old female with history of Alzheimer's, Dementia and decubiti ulcers was admitted on 6/25/11. It was noted that the patient's daughter signed the General Consent for Treatment form on 6/25/11; however, the IM notice was not provided to the patient's daughter when there was evidence that she was involved in the patient's care. In the copy of the IM dated 6/28/11, staff notes the patient is unable to sign due to her cognitive status.

Review of MR #9 on 6/28/11 noted that this 85-year-old male with Parkinson's Disease and Alzheimer's was admitted in the hospital on 6/22/11. It was noted that the patient's son gave consent for blood transfusion on 6/24/11. The patient's son was not provided with the IM notice when there was evidence that he was involved in the patient's care. The Important Message from Medicare form (IM) dated 6/28/11 notes that the patient is unable to sign.

Review of MR #10 on 6/29/11 at 1:00PM noted this 84 year-old-year female was admitted on 6/26/11 and discharged on 6/28/11. The General Consent for Treatment was signed by the patient's daughter. The patient's granddaughter signed the discharge summary and plan. However, a copy of the notice of Discharge & Appeal Rights found in the record was not signed. In addition, there was no evidence that the patient's representative was furnished with the Important Message from Medicare.

The facility's Discharge Planning Policy No: DP-1 was reviewed on 6/28/11. This policy indicated that all Medicare Patients will receive an "IM Important Message from Medicare (IM)" within forty-eight (48) hrs of admission and a second IM notice, forty-eight (48) hours prior to discharge. It was determined that the facility was not effectively implementing its policy.

Similar findings were noted for the patients in MR #15 & MR #16 with family involvement but no evidence that IM notices were provided to patient's representatives on behalf of the patients.
.

.
Based on interview, the review of medical records and other documents, nursing staff did not ensure that patients identified with pressure ulcers received appropriate care consistent with the facility's policies and procedures. This finding was noted in two (2) of three (3) applicable records.

Findings include:

MR #1
This 88-year-old patient with multiple medical conditions was admitted on 6/13/11 for the treatment of Acute Renal Insufficiency. The initial "Nursing Admission History and Assessment" revealed the patient has weakness of upper and lower extremities; presence of bilateral pedal edema; pain to left lower extremity; impaired mobility and needing assistance with activities of daily living. The patient was admitted with a Stage II pressure ulcer on the right lateral thigh. On 6/27/11 a Stage II ulcer, 1.5cm x 1.0cm was identified on the patient's sacrum. The sacral ulcer was not timely recognized and treated in accordance with the hospital policy and procedures on "Pressure Ulcer Management". The policy notes that the Pressure Ulcer Care Team (PUCT) would assess patients with pressure ulcers and the treatment of pressure ulcers should be implemented based on the recommendation of the PUCT. The review of the "Nursing Pressure Ulcer Assessment Progress Note" showed that nurses applied A&D treatment to the sacral ulcer which was not recommended and was not the treatment of choice for a Stage II pressure ulcer. At interview with the unit Nurse Manager on 6/28/11, it was stated that the PUCT assessed the patient on 6/27/11 and found no sacral ulcer. The PUCT at interview confirmed that a referral was made but no sacral ulcer was seen upon assessment. However, on inspection of the patient's skin on 6/28/11 a sacral Stage II ulcer was observed. The PUCT did not confer with the nurses to ensure the patient's care needs were met.

Similarly, the review of MR #2 on 6/28/11 noted an 85-year-old female who was admitted on 6/25/11 for treatment of several medical conditions. The initial admission note dated 6/26/11 at 02:40AM revealed a Stage II, 1cm x 1cm sacral ulcer. The nursing staff noted on the "Nursing Pressure Ulcer Assessment Progress Note" that A&D ointment was applied to the sacral ulcer and it was opened to air. There was no evidence of an assessment by the PUCT. The Pressure Ulcer Care Order Form was not completed by the appropriate personnel to provide for the treatment of the patient's sacral ulcer.
.

.
Based on record review, it was determined that the facility did not consistently ensure that patients have complete medical records. This deficiency was noted in three (3) of twelve (12) medical records reviewed (MRs, #6, #10 & #11).

Findings include:

Review of MR #10 noted that this 84-year-old female presented to the Emergency Department (ED) on 6/26/11 and was triaged at 10:26AM with complaints of muscle aches, poor appetite, weakness, diarrhea, blood stools and leg pains. Although the Millstones in the chart indicated that the patient saw the provider on 6/26/11 at 11:13, the ED provider progress notes were not in the copies of the medical record submitted by the facility on 6/28/11 and on 6/29/11.

Review of MR #6 on 6/28/11 at 11:30AM noted that this 75-year-old patient was admitted to the facility on 6/23/11. It was noted that the Nursing Admission History and Assessment form was incomplete as several pertinent sections on this form were blank.

Review of MR #11 on 6/29/11 noted the Discharge Plan section of this form was not completed.
.

.
Based on observations, record review, and interview during tours of the facility between 6/27/11 through 6/30/11 the hospital did not ensure that the condition of the physical plant and overall hospital environment was developed and maintained in a manner to ensure the safety and well being of patients.

Findings include:

Emergency Department:
During a tour of the Emergency Department (ED) on the afternoon of 6/27/11 the following environmental deficiencies were identified:

1- The ED entrance from Clarkson Avenue was found to have multiple locations that imposed tripping hazards. Examples included but were not limited to:

a- An elevated area outside the entrance of the revolving door.

b- Multiple other locations in the corridor next to the revolving doors inside the hospital that were missing floor tiles.

2- The Ambulance corridor between the Fast Track, Pediatric ED and Adult ED was observed to be partly blocked at both sides by two (2) patient stretchers, an Ultrasonic Machine, two (2) Cardiac Monitors and a BIPAP Machine (Ventilator Support System).

3- The door of the Dirty Linen Room was kept widely open by a linen bag (Infection Control issue).

4- The corridors of the Adult ED were blocked by eight (8) patient beds or stretchers with patients receiving their treatment in the corridor of the ED.

5- The isolation room, A-529, of the Adult ED did not have negative air pressure as required for this type of room, instead it had a positive air pressure, which has the potential to spread infection.

6- The door of the isolation room, A-531, of the Adult ED did not work properly, (the door did not close) and therefore the air pressure of that room could not be tested or maintained as required. This has the potential for the spread of infection.

7- The cord of nurse call of handicapped bathroom A-530 was noted to be wrapped around and tied to the grab bar which prevents its function when needed.

8- The plumbing underneath the hand wash sink of the handicapped bathroom of the Adult ED (Room A1-530) was not insulated or otherwise configured to prevent abrasion or burn of the wheelchair users.

9- There was no handicapped bathroom in the Pediatric ED.

10- There was no isolation room in the Pediatric ED.

11- There was no illuminated exit sign above the second fire exit door of the Pediatric ED.


Psychiatric Unit:
During a tour of the Psychiatric Unit on the morning of 6/28/11 the following environmental deficiencies were identified:

1- The garbage bags used in the patient shower rooms and bathrooms of the psych unit had a plastic lining which make them unsafe for use in the psych unit. When the facility staff were asked to provide documented evidence on the safety of using those bags in the psych unit, they said that the facility will no longer use those bags in the psych unit and that they will replace them with brown paper bags that do not have the plastic lining.

2- All the mattresses in the psych unit had broken and torn surfaces and therefore they can not easily be cleaned and impose an infection control concern.

3- All the patient closets in the patient bedrooms had regular hinges instead of the piano hinges. The regular hinges and the space between the door and door frame impose a looping hazard.

4- The doctor's office, Room 5-406, was noted to have stored boxes very close to the ceiling (< eighteen (18) inches from the ceiling tiles) which can impede the function of the sprinkler system in the event of fire.

5- The cord of the pay phone in the corridor of the psych unit and in front of Room 5-425 was noted to be long (> three (3) feet long) which imposed a looping hazard.

6- The GFI electric outlet in the laundry room was not tamper resistant as required for the psych unit. This imposed an electric safety hazard.

7- The door of bathroom 5-422 had unsafe hardware on it (bi-swing latch which had a sharp edge that can be used for self harm).

8- The cabinet that contains the flammable materials the Activity Room 5-406A was found to be open and the staff could not find the key to lock it. This is a fire hazard and a potential problem in the psych unit.


Central Sterile Supply:
During a tour of the Central Sterile Supply on the morning of 6/29/11 the following environmental deficiencies were identified:

1- The sink used for initial cleaning of the instruments in the decontamination area was noted to be rusty and its vinyl coated layer was falling apart.

2- The preparation and assembly area for the sterile instruments did not have a positive air pressure relative to the corridor outside it, as required. Instead, it had a negative air pressure. This issue is a potential for the spread of infection.


Rehabilitation & Gym:
During a tour of the Rehabilitation & Gym on the morning of 6/29/11 the following environmental deficiency was identified:

There was no soiled holding or soiled utility room available for the rehab and the gym area in the subbasement.

Kitchen:
During a tour of the kitchen on the morning of 6/29/11, it was revealed that that the temperatures of the both the freezer and the refrigerator were outside the range of temperature as set by the hospital policy and the Federal and State regulations (zero or below for the freezer and 40 or below for the refrigerator).

On 6/29/11 in the morning, the temperature of the freezer was 40F and the temperature of the refrigerator was 55F.

At 12:15AM, the temperature of the freezer was 30F and the temperature of the refrigerator was 55F.

When the State Surveyor asked the Director of the Dietary Services why the temperature of the freezer and refrigerator were above the normal ranges, he said that the freezer was in defrost mode and that the door of the refrigerator door was open to store some food. Also, the Director of the Dietary Services stated that both the freezer and the refrigerator were working properly.

Review of the temperature logs of both the refrigerator and the freezer showed that the temperature for both the refrigerator and the freezer were recorded to be within the normal range all the month including the day of inspection (6/29/11).

According the hospital policy and procedure for Refrigerator and Freezer Temperature Monitoring, the temperature of the refrigerator must be less than 40 degrees Fahrenheit and the freezer temperature must be below zero degrees Fahrenheit.

According to the facility policy and procedure if the temperature of either the freezer or the refrigerator is above the normal range, the food temperature should be checked every fifteen (15) minutes. However, this policy did not indicate the time limit for monitoring the food every fifteen (15) minutes when the freezer and the refrigerator are not working properly.

The facility could not fix the problem of the freezer until the State Surveyor left the facility around 5:00PM of 6/29/11 and the State Surveyor asked the facility to monitor the food temperature and discard any food thats temperature might exceed the normal range as per the facility policy and procedure.

Approximately at 4:30PM on 6/29/11, the Director of the Dietary Services told the State Surveyor that the refrigerator was fixed and the freezer trailer had a mechanical failure and could not be repaired.

The facility continued to monitor the food temperature of the freezer until the afternoon of 6/30/11 when the freezer trailer was replaced by another freezer trailer.

The State Surveyor asked the facility to provide a plan that ensure the use of the food items that were stored in the freezer above zero degrees for the period of the trailer freezer's mechanical failure (> twenty-four (24) hours) according to the facility's HACCP plan for food safety.


Fire Alarm and Sprinkler System:
Review of the sprinkler system and fire alarm testing and preventive maintenance records showed that the facility failed to ensure that the sprinkler system and fire alarm system are maintained in fully operational condition.

Findings include but were not limited to:

Sprinkler System - Main Drain Test on 3/4/2010:

1- The OS&Y valves were reported to be corroded with no evidence of follow-up or correcting the problem.

2- Ten (10) tamper valves were reported to be inoperable with no evidence of follow-up or correcting the problem.

3- The water flow switches did not signal.

4- The Subbasement 303C Alarm check and gate valve 35 linen Chute needed to be replaced with no evidence of follow-up or correcting the problem.

5- The sprinkler head in base Trash EM needed to be replaced with no evidence of follow-up or correcting the problem.

6- The distribution piping changes due to internal construction modification must be examined to ensure proper coverage is provided with no evidence of follow-up or correcting the problem.

Sprinkler System- Connection S: 9/24/2010:

1- The water motor gang does not operate at Clarkson Ave.

2- Ten (10) tamper switches do not signal to fire panels.

3- Eight (8) OS&Y valves are corroded and require service.

4- Three (3) water flow switches do not signal to fire alarm panel.

5- The distribution piping changes due to internal construction modification must be examined to ensure proper coverage is provided with no follow up or correcting the problem.

Sprinkler System - Connection S: 11/23/2010:

1- The water motor gang did not operate at Clarkson Ave.

2- The tamper switches did not signal to the fire alarm panel.

3- Eight (8) OS&Y valves are corroded and require service.

4- The distribution piping changes due to internal construction modification must be examined to ensure proper coverage is provided with no evidence of follow-up or correcting the problem.

5- Valve #11 of the water flow switch needs to be replaced with no evidence of follow-up or correcting the problem.

Fire Alarm Initiating Devices: 2nd semi annual test of 2010:

1- The smoke detector at Room A3-504 failed the test. No documented evidence of correcting this problem until the time of the survey.

2- The smoke detector at Room A3-541 failed the test. No documented evidence of correcting this problem until the time of the survey.

3- The smoke detector at Room A3-503 failed the test. No documented evidence of correcting this problem until the time of the survey.

4- The smoke detector IFO Room A2-531 failed the test. No documented evidence of correcting this problem until the time of the survey.

5- The smoke detector IFO Room A2-646 was missing. No documented evidence of correcting this problem until the time of the survey.

6- The duct detector 19-020 at EF-126 was not working.

7- The smoke detector at Stair F - Zone 14/16 was not responding.

8- The smoke detector at elevator Lobby #15/16 was missing device.
.

.
Based on interviews, tours of inpatient units, review of medical record and other documents, it was determined that the facility did not consistently ensure that patients identified as needing post hospital care receive complete evaluation and timely need assessments. This deficiency was noted in six (6) of eleven (11) applicable medical records reviewed (MRs, #5, #10, #11, #12, #13 & #14).

Findings include:

During the unit tour (N 71/73) on 6/28/11 at approximately 10:25AM, MR #5 was reviewed. It was noted that this 71-year-old patient who resided in a skilled nursing facility (SNF) was identified as needing discharge planning. It was noted that the patient was admitted to the facility on 6/14/11. A referral form dated 6/14/11 was faxed to the Social Work Department by nursing staff. The initial Social Work (SW) assessment dated 6/24/11 was done over eight (8) days later. The patient did not have a complete assessment as the following information was not included in the assessment: the patient's bio-psychosocial need; the mental status, family concerns, the date the patient was placed in the SNF; the patient's concerns and issues if any regarding residing in a SNF.

-On 6/24/11, SW noted "PRI (Patient Review Instrument) was sent back to "DSSM" as the patient was there and will return there, at this time DSSM does not have an appropriate bed for patient". The SW did not note if he or she was exploring other possible placement for the patient or the reason why it was not necessary. It was noted that on 6/24/11 the patient was medically stable and the physician placed the patient on ALOC (Alternate Level Of Care) until discharge. There was no documentation that the change in the patient's level of care was fully discussed with the patient or the reason why this was not necessary.

- At interview with the social worker assigned to the unit, the staff stated she saw the patient but did not document the encounter; she agreed that there was a delay in documenting in the record. The SW also stated that a social worker is required to document in the medical record within forty-eight (48) hours after receiving the nursing referral.

-The facility's Discharge Planning Policy indicated that for cases that are referred by nursing due to high-risk diagnosis, the social worker documents in the medical record within twenty-four (24) hours after the referral. This policy however did not address patients needing discharge planning evaluation without a high-risk diagnosis.

Similar findings of incomplete psychosocial assessments were noted in MR #12 and MR #13. Similar findings related to untimely assessments were noted in MR #14 and MR #11.

Review of MR #14 on 6/28/11 at approximately 11:00AM noted that this 76-year-old patient with past history of Dementia and HTN was admitted to Stroke Unit on 6/19/11 with diagnosis of Left Sub-Cortical Infract. It was noted that the patient was admitted on 6/19/11 but the initial social work assessment was dated 6/24/11. On 6/24/11, SW noted "PRI (Patient Review Instrument) had been requested and sent to Rutland and Ditmas Park". There was no documentation that the patient's representative was educated on the residential placement process in language that she understood.

At interview with the patient's wife on 6/28/11 at approximately 12:45AM, she stated she had issues concerning the patient's discharge planning; she reported that her husband was to be discharged to Rutland Nursing Home but she did not know when he would be transferred. She also stated that she was just informed by the MD that paperwork was causing the delay; however, she did not know what paperwork.

The surveyor spoke to the social worker on 6/28/11 at approximately 1:00 PM; the staff reported that the patient was currently on 1:1 observation and the nursing home was requesting more information before the patient could be placed. She also stated that she faxed the information and she was waiting for the facility response. It was noted that the information provided to the surveyor at interview was not documented in the medical record.

The review of MR #10 on 6/28/11 noted a discharge order for the patient dated 6/28/11 at 1:40PM. The patient was on 1:1 observation. An attempt to interview the patient was unsuccessful, as the patient appeared to be confused. The review of MR #10 on 6/28/11 at approximately 4:00PM noted that this 84-year-old patient was admitted to the hospital on 6/26/11. The admitting diagnosis was Diarrhea and Electrolyte Abnormalities. The Nursing Admission History and Assessment form dated 6/26/11 indicated that the patient was alert and oriented. On 6/27/11 the patient's mental status changed; at 10:15PM the nurse noted that the patient was alert x 1 and a high risk for fall. The patient was placed on 1:1 observation. There were no SW notes in the record during the chart review on 6/28/11. However, on 6/29/11, an addendum by the SW dated 6/28/11 at 11:00 indicated that the SW spoke to the patient's daughter and the family was aware that the patient was ready for discharge and were in agreement. The SW notes the patient was to be discharged home this afternoon with no home care. The discharge assessment did not include how the change in the patient's mental status affected the discharge plan. There was no documentation that there was discussion and education with the patient's caregiver on the necessary safety measures. The discharge plan did not include if this was a safe and appropriate discharge for the patient.
.

.
Based on medical record review and unit tour, it was determined that the facility did not consistently provide choice of home care services as required. This deficiency was noted in two (2) of three (3) applicable medical records reviewed (#12 and #13).

Findings include:

The review of MR #12 noted that this 86-year-old patient was admitted to the facility on 6/22/11 with admitting diagnosis of Aspiration Pneumonia. It was noted that the patient was scheduled for discharged to home on 6/28/11. The Social Work (SW) discharge plan dated 6/28/11 notes "Patient is being discharged home. Patient referred to Visiting Nursing Association of Brooklyn for follow-up home care. Discharge was discussed with patient." There was no documented evidence that the patient/patient's representative was afforded the right to a choice of home care agency or why this was not necessary.

Review of MR #13 on 6/29/11 notes a 53-year-old female with a history of HTN and cervical cancer who was admitted to the facility on 3/28/11 with pelvic mass and pain. The patient was discharged on 4/5/11. On 4/1/11 at 12:00, SW noted that she was informed by team that the patient was ready for discharge. The SW noted that referral was made to VNS of NY as the patient has had this service in the past. The assessment did not specify how long in the past that the patient had services with this home care agency or if the patient was satisfied with the services. It was noted that the patient was discharged to home with home care services on 4/5/11. The Social Work discharge Plan dated 4/4/11 indicated that VNS of NY will provide services to the patient at home. On 4/5/11 at 11:00AM, the SW noted patient scheduled for discharge today; she will receive RN evaluation from VNS of NY.
The discharge assessment did not reveal that the patient was afforded the right to make a selection of home care agency. The SW did not document the date home care services will be implemented.
.

.
Based on review of documents and staff interview, it was determined that the hospital did not implement a system to confirm patient choice in the selection of certified home health care agency providers.

Findings include:

The hospital has not developed or implemented a procedure to ensure autonomy in patient selection of certified home health care agency providers who provide post-discharge services(CHHA's).

Interview with the Deputy Director of Social Work on 6/28/11 at approximately 12:00 noon determined the hospital has not implemented a practice for the distribution of written notification to patients regarding options for selection of post discharge home health care agency providers. It was stated that past practice had involved the distribution of a written list to patients that contained agency options, but that this practice had been discontinued for "quite some time".

Reasons reported for the discontinuation of this practice included limitations imposed by insurance providers that direct the hospital to refer to specific agency providers. In addition, it was reported that patients frequently elect to defer choice in selection of agency provider to the hospital staff making the referral. Patients who have services prior to arrival are referred back to the same agency for reactivation of home care following discharge. It was stated there are staff from three home care agencies who work on-site in the hospital and who perform patient assessments before discharge.

Review of the hospital's discharge planning policy on 6/28/11 finds there is no written mechanism to ensure freedom of choice for patient selection in post discharge home care provider. It is noted in the procedure that "if the patient requires skilled nursing care at home, the social worker is to contact any of the three on-site home care agencies for assessment of need and document decision in the medical record." The policy notes the on-site home care agency nurses will screen patients who are referred by the social worker.
.

.
Based on record review and review of documents it was determined that the Emergency Department (ED) did not conduct a full assessment of the special needs of the patients who require modification of interventions for safe care.

Findings include:

Review of MR #17 and incident investigation on 6/29/11 found that a dialysis patient with a new AV fistula in the left arm had a blood pressure cuff applied to the antecubital area in the ED which had to be inflated to a high pressure due to the patient's hypertensive state (215/146) even though there was evidence of the presence of the fistula.

Furthermore, it was found that an IV catheter was also placed in that arm by ED nursing staff which was removed by the transplant team. The patient sustained damage to the fistula but the facility determined that it could not definitively clinically correlate this damage to the blood pressure cuff application.
.

.
Based on review of policies, pre-triage cards, and interviews, it was evident that the Emergency Department did not formulate and implement a policy and procedure to ensure that records of all ED encounters were maintained, entered into the ED log, and integrated into the QA (Quality Assurance) process.

Findings include:

Review of facility triage policy and procedure found that it did not include provisions for retention of pre-triage cards and ambulance call reports (ACRs) on patients who leave the ED prior to triage. At interview with the ED Medical Director on 6/28/11, it was stated that he did not know if any such records were maintained. At interview with supervisory ED staff at the same time, it was stated that ACRs and pre-triage cards are kept for a month and then placed into the recycle bin (disposed). Further interview with other ED administrative staff found that some such records are kept and they provided the survey staff with one ACR dated during the survey and other pre-triage cards with symptoms which included asthma and abdominal pain.

Review of the ED logs found no designation for " left prior to triage." There was no evidence that the cards or ACRs were reviewed for performance improvement/quality assurance purposes.

The facility took immediate corrective action in formulating a policy and procedure on 6/29/11 dated 6/2011 titled "Retention of Information Collected prior to Triage."

The facility does retain the pre-triage cards on patients who are registered and attaches them to the ED record.