HospitalInspections.org

Based on review of facility policy, review of Emergency Department (ED) Central Logs, medical record review and interviews, the facility failed to ensure an accurate ED Log and failed to provide an accurate and complete medical screening examination for 1 patient (Patient #25) who presented to the facility's Emergency Medical Service (EMS) entrance for medical clearance of 25 ED patient's reviewed.

The findings include:

Patient #25 presented to the facility's ED by local police on 11/8/2023 at 3:00 AM, for a medical clearance prior the patient being taken to jail. The patient was in police custody where he was combative and delusional possibly related to ingestion of unknown medications. Local police requested the ED Provider evaluate the patient in the police car. A nursing triage or assessment was not performed for the patient. The ED Provider evaluated the patient in the back of the police car where the patient was lying on his stomach. The patient was taken from the police car and stood up to reposition the patient and placed back in the police car. The patient was on facility property and was not taken into the ED for evaluation or diagnostic testing. The patient was not registered or placed on the ED central log.

Refer to A-2405 and A-2406

Based on review of facility policy, medical record review, review of Emergency Department (ED) Central Logs and interviews, the facility failed to ensure an accurate ED Central log for 1 patient (#25) who presented to the ED for medical clearance for 25 ED patients reviewed.

The findings include:

Review of facility policy "Registration and EMTALA Compliance" dated 10/2021 showed, "...it is the policy for all patients to be medically screened for severity of illness by a qualified and competent nurse and physician...a brief registration with patient name and identifiers is entered into the computer to notify ED staff of a new patient...no registrations will be canceled once the patient has made known to the registration clerk their request for medical care even if the patient leaves at any point in time, including prior to triage. The registration is a record of the patient's presentation in the ED. A medical record is required for each patient treated in the ED..."

Patient #25 presented to the facility's ED by local police on 11/8/2023 at 3:00 AM, for a medical clearance prior the patient being taken to jail. Local police requested the ED Provider to evaluate the patient in the police car. The patient was in police custody where he was combative and delusional possibly related to ingestion of unknown medications. The ED Provider (Physician's Assistant) evaluated the patient in the back of the police car where the patient was lying on his stomach. The patient was on facility property and was not taken into the ED for evaluation or diagnostic testing.

Review of the ED Logs dated 11/8/2023 showed the patient was not listed on the ED Logs. On 12/27/2023 (49 days after the patient was on the ED property) the patient was registered for the 11/8/2023 visit.

During an interview on 1/11/2024 at 10:45 AM, the Chief Financial Officer (CEO) confirmed the patient was not registered in the ED on 11/8/2023 and was not placed on the ED log. The CEO confirmed the patient was on the property of the facility and he was not taken into the ED for evaluation.

Based on review of facility policy, review of a police report, medical record review and interview, the facility failed to provide an accurate and complete medical screening examination for 1 patient (#25) who presented to the facility's Emergency Medical Service (EMS) entrance for medical clearance of 25 ED patients reviewed.

The findings include:

Review of facility policy "Registration and EMTALA Compliance" dated 10/2021 showed, "...it is the policy for all patients to be medically screened for severity of illness by a qualified and competent nurse and physician...a brief registration with patient name and identifiers is entered into the computer to notify ED staff of a new patient...the patient is then assessed by a triage nurse...the medical screening exam will be performed by the ED Physician with this screening and treatment..."

Review of facility policy "Triage" with no date showed, "...patient's presenting to the ER [Emergency Room] will be cared for according to a triage system utilizing as assessment by the ER RN [Registered Nurse]. This will be accomplished by using the triage documentation on the ER record. The process will occur prior to seeing the ER physician..."

Review of a Police Report dated 11/8/2023, showed the local police was dispatched related to a male (Patient #25) was sitting on the porch at a residence who was "sweating profusely and speaking incoherently indicating the use of illegal substance."

Medical record review showed no nursing triage or assessment was performed for the patient on 11/8/2023.

Medical record review of a Provider (Physician Assistant) Physical Assessment dated 11/8/2023 at 3:00 AM showed, "...[named local police Deputies] and [local police] Cop brought over patient in the back of the patrol car that was combative and delusional. Was arrested after being disruptive in town. Police states it took 5 to secure in place in police car. They opened door so I could evaluate medical state before they transported to jail. Pt. [patient] states his name was [Patient #25] but also patient was talking about his sister and [named person]. Patient was in shorts only. There was not visible trauma or cuts/lacerations. Cardiovascular exam RRR [regular rate and rhythm]...lungs clear, moved all extremities well. They got him out & [and] he stood up to reposition into patrol car. Pt. got combative not wanting to get back into car. Patient states he took [unreadable] and 'some kind of shit.' From medical standpoint he is stable. He is hyped up on some drugs of some kind causing him to be delusional & combative at times. Unable to follow-up evaluation psychiatric state due to drugs on board...medically stable @ [at] present, unable to evaluate mental state due to drugs on board..." The assessment recorded the patient's pulse was 76 and respirations 20.

During an interview on 1/11/2024 at 10:45 AM the Chief Financial Officer confirmed the patient was on the property of the facility and he was not taken into the ED for evaluation.

During a telephone interview on 1/11/2024 at 11:32 AM, the Medical Director stated any patient who presents to the ED should receive a medical screening examination for clearance. All patients should have a triage and vital signs recorded. Patients who present by police would need to be taken into the ED for evaluation related to limited access to the patient in the back of a police car and the need for potential diagnostic testing to complete an appropriate medical screening examination.

During a telephone interview on 1/11/2024 at 11:50 AM, Registered Nurse #1 stated the local police brought the patient to the EMS bay and asked the Physician's Assistant [PA] to, "...take a quick look at the patient before they took him [Patient #25] to jail..." The PA saw the patient in the back of the police car and listened to the patient's lungs. The patient was combative, delusional, and yelling. The patient was laying on his stomach in the back of the police car. She stated, "...the police got the patient out of the car and he became more combative. He was placed back in the police car by the officers. He was never brought into the ED...he was so combative..." She confirmed the patient was on the property of the facility, the patient was not triaged, and he was not taken into the ED for evaluation.