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IDAHO FALLS, ID 83404

RECEIVING AN INAPPROPRIATE TRANSFER

Tag No.: A2401

Based on medical record review, incident report review, and staff interview, it was determined the hospital failed to report a potential EMTALA violation of an inappropriate transfer for 1 of 25 Patients (Patient #3) whose records were reviewed. This had the potential to negatively impact all patients under EMTALA guidelines. Findings included:

Patient #3 was a 28 year old female brought in to the ED on 11/27/22, at 4:36 PM, by police. Patient #3's medical record included a police report. The police report for Patient #3 stated:

"...contacted [Patient #3] in the [local hospital] parking lot...[Patient #3] had a blanket wrapped around her person...[Patient #3] spent 6-8 hours wandering around the [local hospital] campus prior to me contacting her....[Patient #3] agreed to walk to the [local hospital] ER. I continued to speak with [Patient #3] in the [local hospital] ER waiting room...I contacted [Deputy] by phone and had him provide transportation to IFC for [Patient #3]...."

Patient #3's Triage note stated: "Pt brought in by [sheriff] from [local hospital] parking lot, on a hold for gravely disabled." Patient #3 was evaluated by ED provider, had lab work completed, and evaluated by behavioral health team. Transfer record indicated Patient #3 was accepted at [local hospital] BHC and was then transferred back to [local hospital] BHC at 9:22 PM via police transport.

The Incident Report for Patient #3 stated: " This patient was brought in by [police], who encountered this patient at [local hospital]. the deputy stated they brought her here because staff in the ED at [local hospital] refused to check her in and giver her a room in the ER." There was no further documentation of follow-up regarding this incident.

The Quality manager was interviewed on 1/25/23, beginning at 4:00 PM. Patient #3's medical record and incident report, were reviewed in his presence. He confirmed Patient #3 was brought in to ED from [local hospital] ED and this was a potential EMTALA violation. When asked if this incident was reported to the state agency or CMS, the Quality manager was unsure. He contacted Risk Management during the interview, who confirmed it had not been reported. The Quality manager confirmed with: "no, I guess we didn't report it...."

The hospital failed to report a potential EMTALA violation.

EMERGENCY ROOM LOG

Tag No.: A2405

Based on review of hospital policy, emergency room log, medical records, and staff interview, it was determined the hospital failed to ensure patients who came to the ED were documented in the ED log for 1 of 25 patients (Patient #7) whose records were reviewed. This resulted in the inability of the hospital to track all patients who came to the ED. Findings include:

A hospital policy titled, "EMTALA Guidelines for Emergency Department Services" dated 11/21/21, included:

"The Emergency Department shall maintain a central log documenting the following information:

a. Each individual presenting to the ED for assistance
b. If the individual refuses treatment
c. If the individual was refused treatment
d. If the individual was transferred, admitted and treated, stabilized and transferred or discharged."

This policy was not followed. An example includes:

Patient #7 was a 21 year old male who presented to the IFCH ED, left the ED, and was transferred back to the IFCH ED from MVH, a hospital that shared the same building. Patient #7 had a laceration above his eye. Patient #7's medical record included a note by an emergency room technician, documented on 10/01/22 at 12:51 PM, which included:

"Patient checked in without incident. Several minutes later stated that hiws [sic] insurance covers care through mvh [hospital that shares building] and asked if the MVH ER was open. Stated that he could go there, and if needed, could return to our ER if we could be helpful to them." There was no additional documentation on the time he left or if an MSE was conducted.

Patient #7's medical record included a "Patient Transfer Record" form. The form included that Patient #7 was transferred from MVH to IFCH on 10/01/22 at 1:37 PM.

Patient #7's medical record included an ED Triage dated, 10/01/22, at 2:06 PM. The note that included, "Chief complaint: states rifle scope struck in forehead last PM (1900). Family wanted him to be seen for stitches. Presented to IFCH ER but left without being seen, presented to MVH ER for same complaint, transferred to IFCH ER per provider orders."

The hospital ED log was reviewed. It included that Patient #7 presented to the ED one time on 10/01/22 and was discharged home.

The IFCH ED manager was interviewed 1/25/23 beginning at 11:30 AM. When asked if Patient #7 was captured in the hospital's emergency room log for the 2 separate visits, he stated Patient #7 was in the ED log one time on 10/01/22. He confirmed there should have been 2 separate visits captured in the log.

The hospital failed to maintain an accurate log of all patients who presented to the ED requesting a MSE.

MEDICAL SCREENING EXAM

Tag No.: A2406

Based on hospital policy, review of medical records, and staff interview, it was determined the hospital failed to ensure patients who came to the ED were documented in the ED log for 1 of 25 patients (Patient #7) whose records were reviewed. This resulted in the inability of the hospital to ensure an emergency medical condition did not exist. Findings include:

A hospital policy titled, "EMTALA Guidelines for Emergency Department Services" dated 11/21/21, included, "All patients shall receive a medical screening exam that includes providing all necessary testing and on-call services within in the capability of the hospital to reach a diagnosis." This policy was not followed. Examples included:

Patient #7's was a 21 year old male who presented to the hospital, left the hospital, and was transferred back to the hospital from a hospital that shared the same building. Patient #7 had a laceration above his eye. Patient #7's medical record included a note by an emergency room technician, documented on 10/01/22 at 12:51 PM, which included:

"Patient checked in without incident. Several minutes later stated that hiws [sic] insurance covers care through mvh [hospital that shares building] and asked if the MVH ER was open. Stated that he could go there, and if needed, could return to our ER if we could be helpful to them."

There was no documentation Patient #7 was seen by a RN, Physician, or Mid level Provider. There was no documentation a triage or MSE was conducted for Patient #7 when he presented to the ED the first time.

Patient #7's medical record included a "Patient Transfer Record" form. The form included that Patient #7 was transferred from MVH ED to IFCH ED on 10/01/22 at 1:37 PM.

Patient #7's medical record included an ED Triage note performed by an ED RN on 10/01/22 at 2:06 PM, after Patient #7 was transferred back to IFCH, which included:

"Chief complaint: states rifle scope struck in forehead last PM (1900). Family wanted him to be seen for stitches. Presented to IFCH ER but left without being seen, presented to MVH ER for same complaint, transferred to IFCH ER per provider orders."

The IFCH ED manager was interviewed 1/25/23 beginning at 11:30 AM. When asked if Patient #7 received an MSE at IFCH ED for his visit on 10/01/22 at 12:51 PM, the ED manager stated he did not. He stated his MSE was provided after the patient was transferred back to IFCH ED from MVH ED at 1:37 PM. When asked why Patient #7 was transferred to IFCH if no further diagnostics or treatment were provided, he stated "I don't know."

The facility failed to ensure all patients seeking care in the ED were provided an MSE.

DELAY IN EXAMINATION OR TREATMENT

Tag No.: A2408

Based on hospital policy, review of medical records, and staff interview, it was determined the hospital failed to ensure an MSE and diagnostic treatments were not delayed for 1 of 25 patients (Patient #7) whose records were reviewed. This resulted in delay in treatment and diagnosis for Patient #7 and had the potential to impact all patients seeking care in the ED. Findings include:

A hospital policy titled, "EMTALA Guidelines for Emergency Department Services" dated 11/21/21, included:
"All Patients shall receive a medical screening Exam that includes providing all necessary testing and on-call services within the capability of the hospital to reach a diagnosis." This policy was not followed. An example includes:

Patient #7's was a 21 year old male who presented to the IFCH ED, left the ED, and was transferred back to the IFCH ED from a hospital that shared the same building. Patient #7 had a laceration above his eye. Patient #7's medical record included a note by an emergency room technician, documented on 10/01/22 at 12:51 PM, which included:

"Patient checked in without incident. Several minutes later stated that hiws [sic] insurance covers care through mvh [hospital that shares building] and asked if the MVH ER was open. Stated that he could go there, and if needed, could return to our ER if we could be helpful to them."

There was no documentation Patient #7 was seen by an RN, Physician, or Mid-Level Provider. There was no documentation a triage or MSE was conducted for Patient #7 when he presented to the ED the first time.

Patient #7's medical record included a "Patient Transfer Record" form. The form included that Patient #7 was transferred from MVH ED to IFCH ED on 10/01/22 at 1:37 PM. Approximately 46 minutes after he presented to the IFCH ED. The transfer record included Patient #7 was transferred due to "Availability of specialized services/personnel to better handle patients condition at the arriving facility."

Patient #7's medical record included an ED Triage note performed by an ED RN on 10/01/22 at 2:06 PM, after Patient #7 was transferred back to IFCH, it included:

"Chief complaint: states rifle scope struck in forehead last PM (1900). Family wanted him to be seen for stitches. Presented to IFCH ER but left without being seen, presented to MVH ER for same complaint, transferred to IFCH ER per provider orders."

Patient #7's medical record included a provider note and assessment, dated 10/01/22 at 2:15 PM, signed by a PA, which included:

"21 year old male who presents emergency department for evaluation of laceration of his forehead that occurred last night approximately 17 hours ago. Wound is closed. there is no further drainage."

It also included, "Injury occurred yesterday as noted above. Do not feel we need to open this back up and repair. wound will heal as is."

The PA who saw Patient #7 was interviewed on 1/25/23 beginning at 11:30 AM. When asked why Patient #7 was transferred to IFCH, he stated he did not know. When asked if any treatment was provided for Patient #7's laceration he stated "no."

The IFCH ED manager was interviewed 1/25/23 beginning at 11:30 AM. When asked why Patient #7 was transferred to IFCH he stated Patient #7 was insistent on getting stitches. He confirmed there was no documentation on the reason Patient #7 was transferred. When asked what "specialized services/personnel," as indicated on the transfer form was available for a laceration, he stated he did not know. When asked if he would consider it an appropriate transfer since Patient #7 needed no additional diagnostics or treatment he stated "I don't know." He confirmed no additional diagnostics or treatments were provided to Patient #7 after he was transferred to IFCH. .

The facility failed to ensure an MSE, diagnostics, and treatment were not delayed for Patient #7.

APPROPRIATE TRANSFER

Tag No.: A2409

Based on record review, and staff interview, it was determined the hospital failed to appropriately identify a transfer to the ED from MVH ED in 1 of 6 transfer patients (Patient #15) whose records were reviewed. This had the potential for a delay in treatment and an unreported EMTALA violation. Findings included:

Patient #15 was an 81 year old male who, according to ED documentation, presented to the ED on 11/02/22 at 8:00 AM, with a chief complaint of left leg pain. Patient #15's medical record also contained a document titled: "Mountain View Hospital Patient Transfer Record", which indicated Patient #15 transferred from Mountain View Hospital ED to IFCH ED on 11/02/22 at 7:55AM. The transfer record was not signed by a physician.

The ED manager was interviewed on 1/25/23, beginning at 12:05 PM. Patient #15's chart was reviewed in his presence. When the ED Manager was asked if he considered Patient #15 a transfer or a walk-in, he stated: "I don't see any documentation of report called to us and I don't see any documentation of why this was a transfer...I can't say that it was an appropriate transfer, all documentation points to a walk-in, except for the transfer form [ from MVH ED]."

The hospital failed to ensure all transfers were documented appropriately.