The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

NYACK HOSPITAL 160 NORTH MIDLAND AVENUE NYACK, NY 10960 Aug. 8, 2016
VIOLATION: ORGANIZATION AND DIRECTION Tag No: A1101
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review, document review and interview, in one (1) of 12 medical records reviewed, it was determined the facility did not ensure that each patient that presented to the Emergency Department (ED) with a complaint of chest pain was appropriately classified and lab specimens completed in a timely manner. (Patients #1)

Findings include:

Review of medical record for Patient #1 revealed the following: This [AGE] year old patient (MDS) dated [DATE] at 1:35 PM with a complaint of chest pain. According to the ambulance care report the patient stated that the previous day she started to have some discomfort in her chest but today the pain got worse. The pain was rated at 10, (on a numeric scale of 0 no pain, to 10, the most severe pain). The pain radiated to her jaw and left arm from the center of her chest. She told the crew that in 2014 she had a heart attack which resulted in a cardiac arrest. EMS gave the patient 3 Aspirin tablets with a dosage of 81 mgs each and transported her to this ED at 1:33 PM.

According to the medical record an electrocardiogram (EKG) which was done at 1:40 PM revealed abnormal finding. The patient was triaged at 1:46 PM and she was assessed as pale but non-diaphoretic; her pain score was rated at 6/10, the pain was described as pressure-like and patient verbalized having an MI (Myocardial Infarction - heart attack) in the past year. The patient was assigned an Emergency Severity Index (ESI) Level of 3 - Urgent. This patient was assigned an ESI Level - Urgent and not an ESI level 2, which required immediate care.
The facility policy titled "Emergency Department Triage: Patient Management," last revised 10/15 indicates an ESI Level 2 (Emergent) for "high risk situation, severe pain/distress, or acute confusion, lethargy, or disorientation."


Labs were drawn at 1:49 PM for cardiac enzymes (Troponin I) but the orders were written at 2:45, and there was no documentation that the specimens were sent to the lab.
Another specimen was collected at 4:23 PM and it was resulted at 4:49 PM, more than 3 hours after the patient's arrival.
The patient was admitted to the Rapid Diagnostic Unit at 6:59 PM for the repeat cardiac enzyme. Another specimen for Troponin I was resulted at 7:46 PM which revealed the level had increased to 1.5 ng/mil (a positive test which is indicative of a Myocardial Infarction). The patient was diagnosed with a Non S-T segment Elevated Myocardial Infarction (NSTEMI), medication treatment was started at 9:39 PM and the patient was transferred to another acute care hospital at 10:09 PM that night.


During an interview which was conducted at 10:15 AM on August 5, 2016, Staff C, the Charge Nurse on 6/7/16, stated that after some time had elapsed after the labs were drawn at 1:49 PM, the patient's ED physician enquired about the Troponin results. When an investigation was undertaken it was determined that the nurse assigned to the patient, had drawn the blood samples at 1:49 PM, but she had not labeled or sent the specimens to the laboratory. The specimens were found at the bedside and discarded.


Staff failed to ensure that the lab testing to rule out the diagnosis of NSTEMI was completed in a timely manner.

These findings were shared with the Director of Quality on August 8, 2016 at 3:00 PM.