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Based on medical record (MR) review, document review and interview, it was determined that in 7 (patient #s 1, 3, 5, 8, 11, 18 & 23) of 23 MRs reviewed of patients who presented to the hospital requesting emergency services, the facility failed to ensure compliance with 489.24 in that the facility failed to provide a medical screening exam and an appropriate transfer.

Findings include:

1. See findings cited at 489.24(1) A2406 and 489.24(e) A2409.

Based on document review and interview, the facility failed to provide a medical screening exam (MSE) for all individuals arriving to the emergency department (ED) for treatment of a medical condition for 2 of 23 medical records (MR) reviewed (patients 1 & 8).

Findings:

1. The policy/procedure Treatment of Patients with Emergency Medical Conditions (approved 12-13) indicated the following: "All patients presenting to the [facility] emergency room for examination or treatment, including minors without a parent and women in labor, shall be given an appropriate medical screening exam by a physician to determine if an emergency medical condition exists. The medical screening exam may include laboratory tests, radiology studies, or consultations, as appropriate."

2. An ambulance trip report indicated on 7-29-15 at approximately 1910 hours that a patient (patient #1) was brought to the ED for treatment and indicated the ambulance was diverted after arrival to the facility.

3. During an interview on 8-26-15 at 1230 hours, the chief nursing officer A3 confirmed that the facility failed to register patient #1 on 7-29-15 and failed to provide an appropriate MSE after the patient's arrival by ambulance for treatment at the ED.

4. During an interview on 8-26-15 at 1610 hours, the chief nursing officer A3 confirmed that the facility was not on diversion on 7-29-15

5. The MR for patient #8 indicated the patient presented to the ED on 6-26-15 at 0550 hours by ambulance for treatment and became agitated shortly after arrival. Law enforcement was requested to respond for assistance and no documentation indicated a physician performed an appropriate MSE for medical clearance prior to law enforcement escorting the patient out of the facility.

6. During an interview on 8-27-15 at 1610 hours, the chief nursing officer A3 confirmed that patient #8 ' s MR failed to indicate an appropriate MSE was provided on 6-26-15 after the patient's arrival by ambulance for treatment at the ED.

Based on document review and interview, the facility failed to ensure a physician certification of transfer risks and benefits and an informed patient transfer consent was completed for all patients transferring from the emergency department (ED) to an accepting facility for 3 of 23 medical records (MR) reviewed (patients 5, 11 & 18) and failed to ensure that a copy of all MR was sent with the patient at the time of transfer for 4 of 23 MR (patients 3, 5, 11 & 23) reviewed.

Findings:

1. The policy/procedure Transfer of Patients To and From Outside Facilities (approved 12-13) indicated the following: "The ED will not transfer patients who are potentially unstable or at reasonable risk to deteriorate due to the natural course of their medical condition ...The patient (or legally responsible person), in writing, requests transfer to another facility. Risk of transfer must be explained and documented. The ED physician has signed a certification ...Certification as described below will include a summary of the risks and benefits upon which the certification is based ...The patient/legal representative is informed of the reason and agrees to the request for transfer ...The receiving facility accepts transfer of the patient ...Acceptance to the receiving facility must be made physician-to-physician with documentation of the facility's physician's name. The transferring facility sends to the receiving facility all medical records (or copies) related to the emergency condition for which the patient has presented. Information is to include: observed signs and symptoms, preliminary diagnosis, treatment administered, test results, informed consents, vital signs and condition prior to transfer, transfer form in which the information is completed in its entirety [and] transfer is provided by qualified personnel and transport equipment."

2. The MR for patient #5 indicated the patient presented to the ED on 6-8-15 at 1400 hours by ambulance after experiencing a cardiac arrest witnessed by family members at a local restaurant. The MR indicated that a family member requested a transfer to a regional hospital after the patient was treated and stabilized in the ED and indicated a physician with admitting privileges at the regional facility accepted the patient in transfer. The MR lacked documentation indicating a physician certification of transfer risks and benefits or a transfer consent was obtained from the patient's representative (family members present in the ED) and lacked documentation indicating a copy of the patient's MR was sent with the patient prior to transfer.

3. The MR for patient #11 indicated the patient presented to the ED on 4-14-15 at 1315 hours by ambulance with a chief complaint of back pain with recent diagnosis of kidney stones. The MR indicated a physician accepted the patient in transfer at a regional facility. The MR lacked documentation indicating a physician certification of transfer risks and benefits or a patient transfer consent was obtained or a copy of the patient's MR was sent with the patient prior to transfer.

4. The MR for patient #18 indicated the patient presented to the ED on 5-18-15 at 1304 hours by ambulance with a chief complaint of left-sided weakness with pain for 3 days. The MR indicated a physician accepted the patient in transfer at a regional facility and the MR lacked documentation indicating a physician certification or a patient transfer consent was obtained prior to transfer.

5. During an interview on 8-27-15 at 1630 hours, the chief nursing officer A3 confirmed that the MR's for patient #s 5, 11 and 18 lacked documentation of a physician certification of transfer risks and benefits or a transfer consent.

6. The MR for patient #3 indicated the patient presented to the ED on 8-10-15 at 1351 hours with a recent diagnosis of a vertebral fracture. The MR indicated a neurosurgeon accepted the patient in transfer and indicated that a courier was dispatched to the ED to obtain a copy of the radiology studies performed during the ED visit. The MR lacked documentation indicating any other ED MR copies were sent with the patient at the time of transfer.

7. The MR for patient #23 indicated the patient presented to the ED on 5-13-15 at 1118 hours by ambulance with a chief complaint of right leg weakness. The MR indicated a physician accepted the patient in transfer at a regional facility and a physician certification and patient consent for transfer was completed. The MR failed to indicate a copy of the patient's MR was sent with the patient to the receiving facility at the time of transfer.

8. During an interview on 8-27-15 at 1635 hours, the chief nursing officer confirmed that the MR for patient's #3, 5, 11, and 23 failed to indicate a copy of the patient's MR was sent with the patient to the receiving facility at the time of transfer.