HospitalInspections.org

Based on staff interviews and review of medical records, policies/procedures and Medical Staff Bylaws, the facility failed to comply with the Medicare provider agreement as defined in 489.20 and 489.24 related to EMTALA (Emergency Medical Treatment and Active Labor Act) requirements.

The facility failed to meet the following requirements under the EMTALA regulations:

Tag A2402 Posting of Signs
The facility failed to post signage visual to all individuals entering the emergency department that specified the rights of individuals, with respect to examination and treatment of emergency medical conditions.

Tag A2405 Emergency Room Log
The facility failed to maintain a central log on each individual who came to the emergency department seeking assistance.

Based on facility observations and staff interviews, the facility failed to post signage visual to all individuals entering the emergency department that specified the rights of individuals,with respect to examination and treatment of emergency medical conditions.
This failure created the potential for patients to be uninformed of their rights regarding examination and treatment for emergency medical conditions.
FINDINGS:
The facility failed to post signage in the ambulance bay, regarding patient rights, with respect to examination and treatment of emergency medical conditions.
a) On 12/17/12 at 3:30 p.m., a tour of the facility's emergency department was conducted with the facility's Regulatory Readiness Coordinator and the ER Nurse Manager. Observations revealed that there was signage in the waiting room of the emergency department, but no signage posted in the ambulance bay, or inside the ambulance bay door, or anywhere else in the Emergency Department to be viewed by individuals who did not enter the Emergency Department through the waiting room.
b) During the same tour, an interview was conducted with the Emergency Department Nurse Manager. S/he stated that the signage had previously been located in the ambulance bay, but had fallen down approximately two weeks ago. S/he further stated the signage was to be replaced later that same day. S/he confirmed that there was no other signage posted inside the Emergency Department that could be viewed by individuals that were brought in by ambulances or outside of the ambulance bay.


\

Based on facility document review and staff interview the facility failed to maintain a central log on each individual who came to the emergency department (ED) seeking assistance.

Findings:

1. The facility failed to document in the central log when Sample patient #20 came to the emergency department with a request for a medical screening examination to be performed.

a. Facility document review (ED Log)
A review of the computerized computer documentation that was identified as the facility's "Central Log" as required for this regulation was reviewed on 12/17/12. The print out did not include an entry on 12/03/12 for Sample Patient #20.

b. Staff interview
An interview was conducted with the hospital's ED Director on 12/17/12 at 3:47 p.m. during observations in the hospital's ED. S/he stated that s/he was familiar with the patient in the complaint (Sample Patient #20) and had spoken to staff in regards to the events of 12/03/12. S/he stated that the patient had been brought into the ED by police and with the Mental Health Center assessor. The assessor had approached the ED charge nurse desk and had stated that they wanted Sample Patient #20 to have a medical screening examination prior to inpatient hospitalization that had been arranged at another hospital. S/he stated that the ED already had two other psychiatric patients in the ED that occupied the two rooms specifically equipped to care for psychiatric patients. S/he stated that the ED Charge Nurse then went to clear out another room to prepare for the patient in the complaint. S/he stated that she did not think the patient was placed in the ED log, and acknowledged that it would be expected that the patient should have been in the log.