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Based on interview and record review, the facility did not complete a Medical Screen Examination (MSE - screening used to determine whether a patient has an emergent (conditions that are potential threats to life limb or function requiring rapid medical intervention or delegated acts) medical condition) and treatment for three of 21sampled patients (Patient 12, Patient 13 and Patient 14) .


This deficient practice resulted in Patient12, Patient 13 and Patient14 not receiving an MSE and evaluation for Emergency medical Condition (EMC), which had the potential for patient harm. Resulting in Patient 12, Patient 13, and Patient14 leaving the facility without being seen. (Refer to A-2406).



Findings:

A. During the concurrent interview and record review, on 4/30/2025 at10:00 am with Emergency Department Manager (EDM), Patient 12 ' s Emergency Department Patient care timeline dated 2/20/2025 was reviewed. The Emergency Department Patient care timeline indicated Patient12 arrived at the Emergency Department (ED) on 2/20/2025 at 7:42 am with a complaint of "Chest pain radiates (spreading) to left arm and left hand was getting purple and tingling (sensation of pins and needles)".

The time of Triaged (Acuity Level-severity of patient ' s illness) at 7:44am, Patient 12 was triaged at Acuity level 2 (Emergent-conditions that are potential threats to life limb or function requiring rapid medical intervention or delegated (give a take or responsibility to another person) acts). Patient 12 ' s vital signs(basic bodily functions used to assess a person ' s health) were; temperature: 97.7 Fahrenheit(F)-a unit of measurement )(normal 97F to 99F); Pulse 85 (normal 60 to 100); Respiration rate (RR): 20breaths per minute (normal RR 12 to 20); Blood Pressure152/93(normal BP 120/80) Pulse oximetry (measurement of oxygen in the blood) 99% on room air (RA), and Pain assessment 8 /10: Left side chest with intermittent(off and on) pressure. Also indicated no rapid medical exam (RME), and no medical doctor (MD) evaluation in the Triage document. Review of Orders include EKG (measure the electrical activity of the heart); Laboratory tests including Troponin (Heart enzyme); Chest Xray, CMP (blood test to measure the body chemical balance). MD order Hydrocodone/ Acetaminophen (medication for severe pain) at10:36am. Medication was not given to Patient12 and documented "not given". Patient 12 Triage Disposition:" Patient called "no answer" 10:40am, Patient Called "no answer":12:46pm; Patient Called no answer:1:27pm. Patient Dismissed 1:52pm

EDM confirmed Patient12 did not have an MSE. Patient 12 did not have an evaluation for left side weakness and chest pain. Patient 12 Disposition Eloped before exam.



B. During a concurrent record review and interview with EDM, on4/30/25 at 10:15 am Patient 13 ' s Emergency Department Patient care timeline dated 2/20/2025 was reviewed. Patient13 presented to ED on 2/20/2025 at 10:55 am with a chief complaint of "Throat pain and Asthma". There was no triage assessment, and No Vital Signs assessment and no evaluation of Patient 13 Complaint of Throat pain and Asthma documented on Patient13 ' s Emergency Department Patient care timeline. EDM confirmed there was no Triage evaluation and Patient first call for Triage was11:42am. A review Patient 13 Emergency Department Patient care timeline triage disposition : "Patient called no answer: 11:42am;" Patient Called no answer: 11:56pm"; Patient Called no answer: 12:39pm". AED confirmed there was no Triage evaluation and Patient first call for Triage was11:56am. AED confirmed, No Vital Signs assessment and no evaluation of Patient 13 Complaint of Throat pain and Asthma.



C. During a concurrent interview and record review, on4/29/25 at 11:25am with (EDM) Patient 14 ' s Emergency Department Patient care timeline dated 2/20/2025 was reviewed. The Emergency Department Patient care timeline indicated Patient14 arrived in the Emergency Department (ED) on 2/20/2025 at 00:45am with a chief complaint of "Chest pain, and Syncope(fainting),near syncope, chest tightness, recently increase Adderall (stimulant medication). Patient14 was Triaged (Acuity Level) 2(Emergent) and the EDM confirmed No Vital Signs were documented. Patient 14 orders included. Review of Orders include EKG; Lab test including Troponin ; Chest Xray, CMP, CBC. EDM confirmed Patient 14 did not have an MSE. Patient called: no answer: 05:05am; Patient called: no answer: 05:43; Patient Called no answer: 06:18am; Patient Dismissed 07:21 am Disposition: Elope after exam, "The Patient was found to elope after receiving a Medical Screening Exam (MSE) or Rapid Medical Exam (RME)"



4/29/25 at 3:00 pm interview with Medical Director of Emergency Department (MDED) ;Director of Quality Patient Safety (DQPS) and Emergency Department Manager (EDM).. The RME MD in ED Triage 8am to 3 am daily. RME completes attestation and the triage MD seen ED Patient and Triage MD orders tests; EKG ... order tests, including Sepsis. eye on Pts, orders tests labs. DQPS stated RME is not an MSE, and the RME does not replace MSE is in addition to MSE, the ED Triage physician Procedures provided and reviewed.



Review of a Facility Policy and Procedure "Triage" dated 9/15/2022" patients presenting to the ED are triaged in a timely manner as possible patient placement is determined by acuity and availability of beds in the ED." Acuity 2. "Acuity level 2 or emergent: Conditions that are potential threat to life. limb or function, requiring, rapid medical intervention or delegated acts"



During review of a Facility policy and procedure titled "EMTALA Guidelines" dated 10/7/2022," "the medical screening examination(MSE) shall be performed by a qualified physician qualified medical person and shall include providing all necessary testing and on call services within the capabilities of the hospital to reach a patient diagnosis and stabilization "" and under section F" medical screening examination: is the screening process required to determine with reasonable clinical confidence whether an emergency medical condition exists this process include could include laboratory tests X-rays and or other diagnostic tests and procedures. Triage does not constitute a medical screening examination."

Based on interview and record review, the facility did not complete a Medical Screen Examination (MSE - screening used to determine whether a patient has an emergent (conditions that are potential threats to life limb or function requiring rapid medical intervention or delegated acts) medical condition) and treatment for three of 21sampled patients (Patient 12, Patient 13 and Patient 14) .


This deficient practice resulted in Patient12, Patient 13 and Patient14 not receiving an MSE and evaluation for Emergency medical Condition (EMC), which had the potential for patient harm. Resulting in Patient 12, Patient 13, and Patient14 leaving the facility without being seen.



Findings:

A. During the concurrent interview and record review, on 4/30/2025 at10:00 am with Emergency Department Manager (EDM), Patient 12 ' s Emergency Department Patient care timeline dated 2/20/2025 was reviewed. The Emergency Department Patient care timeline indicated Patient12 arrived at the Emergency Department (ED) on 2/20/2025 at 7:42 am with a complaint of "Chest pain radiates (spreading) to left arm and left hand was getting purple and tingling (sensation of pins and needles)".

The time of Triaged (Acuity Level-severity of patient ' s illness) at 7:44am, Patient 12 was triaged at Acuity level 2 (Emergent-conditions that are potential threats to life limb or function requiring rapid medical intervention or delegated (give a take or responsibility to another person) acts). Patient 12 ' s vital signs(basic bodily functions used to assess a person ' s health) were; temperature: 97.7 Fahrenheit(F)-a unit of measurement )(normal 97F to 99F); Pulse 85 (normal 60 to 100); Respiration rate (RR): 20breaths per minute (normal RR 12 to 20); Blood Pressure152/93(normal BP 120/80) Pulse oximetry (measurement of oxygen in the blood) 99% on room air (RA), and Pain assessment 8 /10: Left side chest with intermittent(off and on) pressure. Also indicated no rapid medical exam (RME), and no medical doctor (MD) evaluation in the Triage document. Review of Orders include EKG (measure the electrical activity of the heart); Laboratory tests including Troponin (Heart enzyme); Chest Xray, CMP (blood test to measure the body chemical balance). MD order Hydrocodone/ Acetaminophen (medication for severe pain) at10:36am. Medication was not given to Patient12 and documented "not given". Patient 12 Triage Disposition:" Patient called "no answer" 10:40am, Patient Called "no answer":12:46pm; Patient Called no answer:1:27pm. Patient Dismissed 1:52pm

EDM confirmed Patient12 did not have an MSE. Patient 12 did not have an evaluation for left side weakness and chest pain. Patient 12 Disposition Eloped before exam.



B. During a concurrent record review and interview with EDM, on4/30/25 at 10:15 am Patient 13 ' s Emergency Department Patient care timeline dated 2/20/2025 was reviewed. Patient13 presented to ED on 2/20/2025 at 10:55 am with a chief complaint of "Throat pain and Asthma". There was no triage assessment, and No Vital Signs assessment and no evaluation of Patient 13 Complaint of Throat pain and Asthma documented on Patient13 ' s Emergency Department Patient care timeline. EDM confirmed there was no Triage evaluation and Patient first call for Triage was11:42am. A review Patient 13 Emergency Department Patient care timeline triage disposition : "Patient called no answer: 11:42am;" Patient Called no answer: 11:56pm"; Patient Called no answer: 12:39pm". AED confirmed there was no Triage evaluation and Patient first call for Triage was11:56am. AED confirmed, No Vital Signs assessment and no evaluation of Patient 13 Complaint of Throat pain and Asthma.



C. During a concurrent interview and record review, on4/29/25 at 11:25am with (EDM) Patient 14 ' s Emergency Department Patient care timeline dated 2/20/2025 was reviewed. The Emergency Department Patient care timeline indicated Patient14 arrived in the Emergency Department (ED) on 2/20/2025 at 00:45am with a chief complaint of "Chest pain, and Syncope(fainting),near syncope, chest tightness, recently increase Adderall (stimulant medication). Patient14 was Triaged (Acuity Level) 2(Emergent) and the EDM confirmed No Vital Signs were documented. Patient 14 orders included. Review of Orders include EKG; Lab test including Troponin ; Chest Xray, CMP, CBC. EDM confirmed Patient 14 did not have an MSE. Patient called: no answer: 05:05am; Patient called: no answer: 05:43; Patient Called no answer: 06:18am; Patient Dismissed 07:21 am Disposition: Elope after exam, "The Patient was found to elope after receiving a Medical Screening Exam (MSE) or Rapid Medical Exam (RME)"



4/29/25 at 3:00 pm interview with Medical Director of Emergency Department (MDED) ;Director of Quality Patient Safety (DQPS) and Emergency Department Manager (EDM).. The RME MD in ED Triage 8am to 3 am daily. RME completes attestation and the triage MD seen ED Patient and Triage MD orders tests; EKG ... order tests, including Sepsis. eye on Pts, orders tests labs. DQPS stated RME is not an MSE, and the RME does not replace MSE is in addition to MSE, the ED Triage physician Procedures provided and reviewed.



Review of a Facility Policy and Procedure "Triage" dated 9/15/2022" patients presenting to the ED are triaged in a timely manner as possible patient placement is determined by acuity and availability of beds in the ED." Acuity 2. "Acuity level 2 or emergent: Conditions that are potential threat to life. limb or function, requiring, rapid medical intervention or delegated acts"



During review of a Facility policy and procedure titled "EMTALA Guidelines" dated 10/7/2022," "the medical screening examination(MSE) shall be performed by a qualified physician qualified medical person and shall include providing all necessary testing and on call services within the capabilities of the hospital to reach a patient diagnosis and stabilization "" and under section F" medical screening examination: is the screening process required to determine with reasonable clinical confidence whether an emergency medical condition exists this process include could include laboratory tests X-rays and or other diagnostic tests and procedures. Triage does not constitute a medical screening examination."