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ST JOHN'S EPISCOPAL HOSPITAL AT SOUTH SHORE 327 BEACH 19TH STREET FAR ROCKAWAY, NY 11691 Dec. 7, 2012
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
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Based on observations, record reviews and staff interviews during an EMTALA Survey, the facility failed to ensure that a licensed practitioner assessed the patient on presentation to the emergency room to determine the acuity of the patient's condition and the priority of triage for six (6) out of thirty (30) medical records reviewed (Patients #2, #3, #4, #14, #16 and #18).

Findings:

Observations at 10:00AM on 12/05/12 revealed signage in different languages that directed the patients presenting to the emergency room to see the Registrar first before speaking with the Triage Nurse.

Review of the medical record for Patient #3 revealed the patient was quick registered on 12/04/12 at 8:40PM then triaged at 9:28PM, forty-eight (48) minutes later.

Review of the medical record for Patient #18 revealed the patient was quick registered at 10:04AM on 12/07/12, but not triaged until one (1) hour and thirty (30) minutes later at 11:30AM.

Review of additional medical records for Patients #2, #4, #14 and #16 revealed a sixteen (16) minute to forty-six (46) minute delay between quick registration and the documented triage by a licensed practitioner.

On interview at 10:45AM on 12/05/12 the Registrar (Staff Member #5) stated "When someone comes to the window I ask them if they want to be seen and if they say yes I take their ID and start the pre-registration in the computer. Then I ask them their chief complaint which, I enter as well. Depending on what they say, for instance, if it's something like chest pain, I send them straight to the Triage Nurse, or if it's something like the flu, I tell them to take a seat and the nurse will see them."

On 12/07/12 at 11:15AM a pre-registration was observed and the Registrar (Staff Member #6) stated to a man and woman who presented at the window "Do you want to see someone?" The man replied "Yes, my girlfriend does". The Registrar stated "Show me a photo ID" and entered the data into the computer. The Registrar stated "Why are you here?" The man replied "She has a problem with her ear". The Registrar stated "OK take a seat and a Triage Nurse will be with you soon".

The Triage Nurse (Staff Member #4) stated at 11:15AM on 12/05/12, if more than one (1) patient is waiting she will "Review the computerized registration to determine what the patient's complaint is then take the next patient based on their complaint" and "Sometimes I take out of order (of arrival)".

Review of the current "Job Description - Performance Appraisal" for a "Registrar" revealed the position requires a High School Diploma and the "Core Responsibility was to receive and register all emergency room patients, enter them in the on-line system then determine the needs and direct accordingly" which contradicts the "emergency room Quick Registration" Policy.

Review of the Administrative Policy and Procedure titled "emergency room Quick Registration" dated September 11, 2012 documented that "As soon as the patient arrives, the Registrar will "Obtain basic information to identify the patient" including "The chief complaint or reason for coming to the ED". The "Patient will then be immediately triaged by the Registered Nurse in the same area".