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REGIONAL HOSPITAL OF SCRANTON 746 JEFFERSON AVENUE SCRANTON, PA 18501 March 13, 2017
VIOLATION: EMERGENCY SERVICES POLICIES Tag No: A1104
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility policy, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure an EKG was completed within ten (10) minutes of a patient arriving in the Emergency Department complaining of chest pain for three of 24 medical records reviewed (MR1, MR8, MR16).

Findings include:

[Stemi or STEMI - ST Segment Elevation Myocardial Infarction]

1) Review on March 6, 2017, of the facility's "ED Stemi flowchart," last revised December 2015, revealed the following steps for staff to take regarding a possible Stemi patient:
ED walk in EKG done within 10 minutes
EMS-Pre Hospital EKG
ST Elevation Identified Yes
Contra-indications to Invasive Revascularation? (Severe Co-morbidities, Cath Lab Unavailable, Patient Refusal No
ED MD or Staff Activates Cath Lab by calling 55 to hospital switchboard and operator initiates blast page and announces overhead "Stemi Alert ETA X"
ER MD Notifies STEMI Interventionalist and writes order for cath. ...

Review on March 6, 2017, of MR1 revealed the patient arrived in the Emergency Department (ED) on February 2, 2017 at 11:21 PM via ambulance from home with the chief complaint of mid-sternal/epigastric pain. The triage assessment was completed by EMP4 on February 3, 2017, at 12:29 AM. The EKG was performed by EMP4 at 1:40 AM. The EKG revealed acute ST elevation. OTH1 reviewed the EKG at 2:25 AM, and a STEMI alert was called. The patient was transferred to the cardiac catheterization lab at 3:09 AM for acute ST-segment elevation myocardial infarction with ongoing chest pain. The patient developed cardiogenic shock while in the cardiac catheterization lab, and a balloon pump was placed. The patient was transferred to the intensive care unit and expired on [DATE].

Interview on March 6, 2017, with EMP1 at approximately 10:00 AM confirmed EMP4 did not follow the ED Stemi flowchart. EMP1 confirmed an EKG was not performed on MR1 within ten (10) minutes of entering the ED.

Review on March 6, 2017, of MR8 revealed the patient walked into the ED on January 23, 2017, at 2:46 PM with the complaint of atypical chest pain. The EKG was performed at 3:33 PM.

Interview on March 6, 2017, with EMP3 confirmed MR8 walked into the ED on January 23, 2017, at 2:46 PM with the complaint of atypical chest pain, and an EKG was performed at 3:33 PM. EMP3 confirmed the EKG was not performed within 10 minutes of ED walk in.

Review on March 6, 2017, of MR16 revealed the patient walked into the ED on February 3, 2017, at 6:09 PM with a complaint of left sided chest pain and back pain. The EKG was performed at 6:51 PM.

Interview on March 6, 2017, with EMP3 confirmed the patient walked into the ED on February 3, 2017, at 6:09 PM with a complaint of left sided chest pain and back pain. The EKG was performed at 6:51 PM. EMP3 confirmed the EKG was not performed within 10 minutes of ED walk in.