HospitalInspections.org

Based on facility tour and employee interview (EMP), it was determined that the facility failed to post EMTALA signage that was clearly readable at a distance of at least 20 feet.

Findings include:

1. At approximately 11:18 AM on November 26, 2019, during a tour of the Emergency Department, the posted EMTALA signage located within the waiting area, the triage area, eight exam bays, and two trauma bays, were not visible from approximately 20 feet.

2. When asked if [he/she] could read the content of the posting near the triage area when standing a distance of approximately 20 feet away, EMP2 was unable to read the entire content of the posting.

Based on review of facility documentation and employee interviews (EMP), it was determined that the facility failed to maintain a complete central log on each individual who came to the Emergency Department, for 157 of 642 entries from September 2019-November 25, 2019.

Findings include:

1. Review, at approximately 10:30 AM on November 27, 2019, of the presented ED Log, revealed 52 of 222 entries in October that were incomplete. Review of the November log revealed 39 of 168 entries that were incomplete. Review of the September log revealed 66 of 252 entries were incomplete.

2. When asked, at approximately 11:25 AM on November 27, 2019, EMP2 confirmed that the facility did not have a policy relative to the ED Log.

Based on review of facility documentation and medical records, as well as employee interviews (EMP), it was determined that the facility failed to provide a medical screening examination for one of 27 patients presenting to the facility between September 2019-November 25, 2019 (MR18).

Findings include:

Review, at approximately 12:01 PM on November 26, 2019, of "EMTALA Compliance," revision dated June 2015, revealed, "... Policy: All patients arriving on hospital property seeking emergency care will be examined by an Emergency Department Physician or Private Physician. Thus ensuring compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) from the consolidated omnibus reconciliation act (COBRA) of 1986. Standard: Any patient arriving on hospital property manifesting symptoms of an "Emergency Medical Condition" as interpreted by COBRA Law will be examined by a Physician. 1. A patient arriving on Hospital Property seeking or presumably seeking "Emergency Care" must be examined by a physician; ..."

1. Review, at approximately 2:55 PM on November 27, 2019, of MR18 revealed that the patient presented via ambulatory method to the facility's ED with a chief complaint of right eye double vision. Review of the patient's medical record revealed "Not seen in ED," handwritten on every page. The only other documentation provided in the patient's medical record was included on the E.D. Triage Assessment, which stated, "... Chief Complaint: double vision R [right] eye. (Requesting MRI stat). ..." The medical record did not reveal documentation of an assessment of the patient, vital signs, testing, etc.

2. Review of the facility's ED Central Log revealed documentation that the patient for MR18 was placed in Trauma Room 1 at the time of arrival to the facility.

Based on review of facility documentation and medical records (MR) as well as employee interviews (EMP), it was determined that the facility failed to ensure appropriate transfer, effected through qualified personnel and transportation equipment for 11 of 23 transfer medical records (MR1, MR2, MR12, MR14, MR16, MR17, MR21, MR22, MR24, MR26, and MR27); failed to ensure transfer orders for two of 23 transfer patients (MR2 and MR11); and/or failed to ensure that the documentation of informed consent for transfer was documented completely for 23 of 23 transfer medical records (MR1, MR2, MR3, MR4, MR5, MR6, MR7, MR8, MR9, MR10, MR11, MR12, MR14, MR15, MR16, MR17, MR19, MR20, MR21, MR22, MR24, MR26, and MR27).

Findings include:

Review, at approximately 2:06 PM on November 26, 2019, of "Transfer of Patient from Emergency Department to Another Hospital or Health Care Facility," revision dated June 2015, revealed, "... After stabilization, a safe and efficient transfer of the patient to another hospital or health care facility will be provided. ..."

Review, at approximately 2:20 PM on November 27, 2019, of the "Transfer of Patient to Another Acute Care Facility," policy, review/revised September 2017, revealed, "... The patient being transported to another acute care facility will be transported by the appropriate mode of transportation (ambulance or aeromedical), and accompanied by the appropriate level of professional caregiver (EMT, Paramedic and/or Registered Nurse), as requested by the physician, to provide ongoing continuity of care until the patient is delivered to the receiving facility. ... Procedure: ... 3. ... The physician must explain the risks and benefits of the transfer to the patient and/or the person acting on behalf of the patient and consent is then obtained. ..."

1. Review, between 12:30 PM and 2:30 PM on November 25, 2019; 9:45 AM and 12:00 PM on November 26, 2019; and between 2:30 PM and 3:30 PM on November 27, 2019, of MR3, MR6, MR8, MR9, MR10, MR12, MR16, MR17, MR22, MR24, MR26, and MR27 revealed incomplete portions of the "Physician Recommended Transfer," on the Consent to Transfer, inclusive of: ED Physician's name; receiving facility; accepting physician name; and/or benefits and risks.

2. Review, between 12:30 PM and 2:30 PM on November 25, 2019, and 9:45 AM and 12:00 PM on November 26, 2019, of MR2 and MR11 revealed no transfer orders.

At approximately 10:50 AM on November 27, 2019, EMP2 provided confirmation in e-mail format that there were not transfer orders on MR2 and MR11.

3. Review, between 12:30 PM and 2:30 PM on November 25, 2019; 9:45 AM and 12:00 PM on November 26, 2019; and between 2:30 PM and 3:30 PM on November 27, 2019, of MR1, MR2, MR4, MR5, MR7, MR8, MR9, MR10, MR11, MR12, MR14, MR15, MR16, MR19, MR20, MR21, and MR22 revealed benefits and risks to include only the following: "... Benefits: CT Scan Risks: Travel ..."; "... Benefits: CT availability Risks: travel ..."; "... Benefits: Specialty Care Risks: travel ..."; "... Benefits: Higher level of care ... Risks: MVA ..."; "... Benefits: Higher level of care Risks: MVC ..."; "... Benefits: further evaluation Risks: travel ..."; "... Benefits: CT Scan Risks: MVA ..."; "... Benefits: Specialty care Risks: traffic ..."; "... Benefits: higher level of care Risks: travel ..."; "... Benefits: Specialized Care Risks: Travel ..."; "... Benefits: Ortho Specialty Risks: travel ..."; "... Benefits: higher level of care personal vehicle Risks: travel ..."

4. Review, between 12:30 PM and 2:30 PM on November 25, 2019; 9:45 AM and 12:00 PM on November 26, 2019; and between 2:30 PM and 3:30 PM on November 27, 2019, of MR1, MR2, MR12, MR14, MR16, MR17, MR21, MR22, MR24, MR26, and MR27 revealed documentation of the patient being transferred to another acute care facility via private vehicle, without supporting documentation for cause.