HospitalInspections.org

Based on tours and observations of the emergency department (ED) and staff interviews, it was determined the hospital failed to ensure conspicuous display of signs that specify the rights of patients to examination and treatment of emergency conditions and for women in labor in accordance with Section 1867.

Findings include:

A tour of the ED on November 3, 2010 at 11:05 AM revealed inadequate display of required signs which notify patients with emergency medical conditions and women in labor of their rights to an examination and treatment.

Two signs were displayed on 8 ? X 11 paper in English and Spanish, below eye level behind a stand near the information desk. The signs were obstructed from view since they were behind the stand. Staff #1 witnessed this finding at that time. The same finding of the obstruction of these signs was also observed on November 8, 2010 at approximately 10:15 AM.

During further tours of the ED on November 3, 2010 at 11:10 AM, it was noted that there were no signs in the waiting area, ambulance entrance, registration area or ED core as required. Therefore patients who enter the ED via the ambulance entrance or who bypass the information desk, are not able to see any signs with this required information.

Based on a review of the medical record, document reviews and interviews, the facility failed to provide gastroenterology services to patients in a timely manner to determine if an emergency medical condition existed. (MR #1).

Findings include:

1. Review of MR #1 revealed that the patient arrived at the ED at 5/1/10 at 1:30 AM with intestinal bleeding. The patient was triaged as emergent and was seen by a physician "immediately on arrival because of high probability of imminent or life threatening deterioration in patient's condition." Previous medical history included Colonic Cancer diagnosed a week before and Gastric Ulcer with hemorrhage 40 years ago. "BP on arrival was 60/30, he was diaphoretic and appeared to be decompensating." The patient vomited a large amount of blood in the ED. Various treatments were ordered and provided, including a blood transfusion. The ED physician documented that the patient's condition on discharge to the ICU at 5:45 AM, was "critical." The patient was not taken for an endoscopy on 5/1/10 until 9:15 AM, approximately 8 hours after arrival to the ED, and to the operating room for an emergent Gastrectomy until 11:12 AM that morning after the surgeon noted that the "patient is too unstable for transfer or to wait."

2. Review of the hospital's emergency on-call schedule for May 2010 revealed that from 5/1/10 through 5/3/10 there was no gastroenterology coverage for the emergency department. There was no indication that any attempt was made to transfer MR #1 since there was no GI coverage that night. Furthermore, there was no evidence that a surgical consult was requested while the patient was in the ED.

3. During staff interviews, Staff #2, the Medical Director of the Emergency Services stated on November 8, 2010 at approximately 11:30 AM, that the decision not to transfer the patient for emergency care was a judgement call and that the ED physician determined that the patient's condition was not emergent. However, this is not consistent with the patient's presenting condition.

4. A review of the facility's rules and regulations for the medical staff for "responsibilities of consultant " revealed "in emergency cases, the consultant shall respond in a timely fashion." However, in this case, the patient was never treated by a GI specialist up to almost 8 hours after presentation in the ED. This is not a timely consult given the patient's "emergent" condition.