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UPMC PRESBYTERIAN SHADYSIDE 200 LOTHROP STREET PITTSBURGH, PA 15213 Oct. 9, 2014
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
Based on a review of facility policy, facility documents and staff interviews (EMP), it was determined that the facility failed to provide an appropriate medical screening examination within the capability of the hospital's Emergency Department (ED) for one of 33 medical record reviewed (MR33).

Findings include:

A review of the facility policy, "Emergency Medical Treatment and Active Labor Act (EMTALA), " dated 7/2014 states, " ..... If an individual seeking emergency medical care comes to the hospital's Dedicated Emergency Department, physician or other Qualified Medical Person (QMP) (determined by the hospital's medical staff bylaws or rules and regulations) shall offer a Medical Screening Exam to such person ... even when he does not request examination or treatment if a Prudent Layperson Observer (as opposed to a health professional) would believe, based upon individual needs, examination or treatment for a medical condition .....Medical Screening Exam (MSE) is an appropriate exam within the capability of the hospital to determine whether an emergency medical condition exists."
A review of the facility's Emergency Department (ED) Registration Log revealed that MR33 was registered in the ED log on 9/6/2014. Additional review of the log revealed no physician assigned to MR33 and "none" was listed for discharge disposition.
During an interview on 10/7/2014 at 11:00 AM, EMP1 recounted working in the ED on 9/6/2014, when MR33 was brought to the ED by EMS personnel. EMP1 reported being surprised by the arrival, as usually the ED receives a notice via med command of a patient arriving. EMP1 asked the paramedic what was going on. The paramedic explained that MR33 was just discharged from 5 Main of the hospital; however MR33 ' s blood pressure was high. EMP1 checked the discharge papers and the handoff report. EMP1 explained that the report was generated by the physician, so 5 Main had to know the patient's blood pressure was high. EMP1 thought it was documented at 200/96. EMP1 asked the paramedic if there were additional concerns. The paramedic said "no" just the blood pressure. EMP1 then called 5 Main and spoke with a nurse who reported that the reading was consistent with the patient's recorded blood pressures while an inpatient on 5 Main. EMP1 stated that the registration log was not checked to see if MR33 was registered. EMP1 noted that MR33 was not competent to answer questions because of Dementia. EMP1 stated that she thought the husband of MR33 was asked if there was a new problem or if they wanted MR33 to be seen. EMP1 reported the husband was told that, if preferred, MR33 would be seen in the ED or taken back to 5 Main to be seen by doctors and/or nurses. The husband was okay with having his wife transferred to the skilled nursing facility (SNF). Additionally, EMP1 stated that she did not advise them to leave or try to persuade them to leave without being seen.
During an interview on 10/7/2014 at 9:30 AM, EMP2 stated that the patient was on 5 Main ready for discharge. The patient had been having high blood pressure readings. The patient was discharged and an ambulance was called. The EMT arrived and took the patient. The paramedic took MR33's blood pressure prior to leaving hospital grounds. The blood pressure reading was higher than the previous readings recorded while admitted . The paramedics took the blood pressure a few more times and all were high reading. As a result, the EMT took MR33 into the facility's ED. They went through the regular ambulance area straight to registration. MR33 was registered then was wheeled down the hall to the charge nurse. MR33 was not taken to a treatment room. The charge nurse called 5 Main to get information about MR33 while a patient on the floor. The nurse on 5 Main acknowledged being aware that MR33 had high blood pressures. The EMT, MR33, and husband were all present. The charge nurse said to the EMT, "Are you ok to leave?" The EMT said they were okay to leave, so they left. The ambulance left and transported MR33 to a local SNF. The EMT informed the SNF that MR33's blood pressure reading was high. Staff at the SNF told paramedics that MR33's pressures were too high and instructed the EMT to keep the patient in the ambulance and take to another (receiving) hospital. The patient was taken to another (receiving) hospital. A MSE was completed at the receiving hospital and the patient was given hydralazine. The receiving hospital wanted to admit the patient. The family wanted MR33 to go back to transferring hospital. MR33 was taken via ambulance back to the transferring hospital.
A review of the ED Evaluation at the receiving hospital indicated that on 9/6/2014 at 7:15 PM, the patient was given Hydralazine 20 mg IV push due to elevated blood pressure.