HospitalInspections.org

Based on record review, staff interview and review of the provider schedule, the facility failed to have 24 hour coverage of the emergency department (ED) on 1 day (3/7/24) out of 5 months reviewed. This failed practice had the potential to affect all patients coming to the ED. The Rural Emergency Hospital (REH) averages 25 ED patients per month.

Findings are:

A. Review of the facility provider (Physician; DO; Physician Assistant; Nurse Practioner) schedule for the Emergency Department from 1/1/24 through 6/6/24 identified that on 3/7/24 the facility lacked provider coverage for 9 hours and 45 minutes. Per the March 2024 provider schedule, on 3/7/24 the facility lacked coverage from 12:08 PM to 9: 53 PM.

B. Interview with the Director of Nurses on 6/5/24 at 1:00 PM stated, "The local Rescue Squad was notified that there was not a provider available from 12:08 PM on 3/7/24, so the ambulance needed to divert (go to a different hospital) from this hospital. They were then notified that at 9:53 PM on 3/7/24 at 9:53 PM that the hospital is no longer on diversion. A provider was available at that time.

C. Interview with the Interim CEO (Chief Executive Officer) on 6/6/24 at 10:28 AM, revealed that the CEO had been aware that there was a time on 3/7/24 without coverage. "I had tried myself to call agency providers, and a prior physician that had worked here. We were unable to find anyone." When asked if any patients came to the Emergency Department during the time on 3/7/24 without coverage, "No, we didn't have anyone come to the ED during that time."

D. Review of the policy titled "Emergency Department Physician Availability" reviewed 1/2024, identified that the facility Emergency Room Staff is to notify the on-call medical provider when a patient presents to the emergency room. The provider is to be available by telephone, on a 24 hour a day basis, a medical provider to receive emergency calls and provide medical direction in emergency situations.

E. Review of the medical record for Patient 1, that was seen in the ED on 3/7/24, for complaint of diarrhea, and dehydration. The patient was admitted to observation following the ED visit on 3/7/24. The provider going off duty at 12:00 Noon gave observation patient care orders prior to going off duty. The medical record for Patient 1 identified the patient received IV (intravenous fluids) and was provided the prescribed medication, and meal by the nurse.

F. Interview with the Chief Clinical and Operational Manager on 6/6/24 at 2:45 PM when asked, what were the nursing staff to do on 3/7/24 if the observation patient needed medical care when there was no available provider, "I would have had them take the patient back to the ED and use the e care telemedicine physician." When asked if there is any type of plan in place if it would happen again that they are without a provider and have an observation patient, "Not in writing."