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OSCEOLA REGIONAL MEDICAL CENTER 700 WEST OAK STREET KISSIMMEE, FL 34741 March 23, 2012
VIOLATION: INTEGRATION OF EMERGENCY SERVICES Tag No: A1103
Based on interview and record review, the facility failed to obtain timely cardiac marker laboratory services for 1 of 10 sampled patients entering the facility emergency department (ED) with complaints of chest pain (#1).

Findings:

Record review of patient # 1's record revealed the patient entered the ED on 3/15/12 at 2:17 p.m. complaining of chest pain and a history of myocardial infarction.

Physician orders revealed electronic documentation on 3/15/12 at 2:31 p.m. for a troponin level for diagnostic purposes. The record documented an elevated troponin level on 3/15/12 at 3:42 p.m.

Review of the facility ED policy "CARDIAC MARKERS/CARDIAC ENZYMES #EMS.003.2" revealed: PURPOSE: To more quickly and accurately identify the patient having an MI. POLICY: Patients who present with chest pain will have cardiac markers drawn on arrival as ordered by MD. PROCEDURE # 4: Cardiac markers are performed in the ED, results available in 10 minutes.

Interview with the director of nursing and the ED manager related the facility was over capacity on 3/15/12 and was in "surge plan" as the hospital had no open beds and the ED census was over capacity at 55. (ED census 25). They further related the facility was doing the best they could considering the overcapacity problems and were prioritizing by condition of the patient. Patient #1's troponin levels should have been performed immediately as ordered at 2:31 p.m. and were unable to explain the delay of patient #1's initial troponin level dated/timed as 3/15/12 at 3:42 p.m.