HospitalInspections.org

Based on record review, video review and interview, the hospital failed to maintain an accurate and complete Emergency Department Central (patient) Log on each individual who came to the Emergency Department as evidenced by failing to document in the central log a patient who came to the Emergency Department for 1 (#2) of 20 (#1-20) patients sampled.

Findings:

Review of the hospital's policy titled Louisiana EMTALA- Central Log Policy Reviewed 10/2021 revealed in part:
The hospital will maintain a Central Log containing information on each individual who comes to the hospital campus requesting assistance or whose appearance or behavior would cause a prudent layperson observer to believe the individual needed examination or treatment, whether he or she left before a medical screening examination (MSE) could be performed, whether he or she refused treatment, whether he or she was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged.

A review of the emergency department log for 05/14/2023 failed to reveal Patient #2.

A review of video footage from 05/14/2023 revealed:
At 7:07 in the morning, Patient #2's father enters the Emergency Department patient reception area. S5Reg is sitting at the reception desk and engages with the patient and his father. The child is sitting on the desk with his back to S5Reg while Patient #2's father appears to speak with S5Reg.
At 7:09 S5Reg gets up from her chair behind the reception desk. Patient #2's father is seen carrying Patient #2 behind the reception desk. S5Reg appears to engage with the patient while Patient #2's father stands back and watches.
At 7:10 S5Reg walks into the patient triage area leaving Patient #2 and his father waiting in the chairs behind the reception desk. Once in the nurse's triage area, S5Reg locates a stethoscope in the drawer next to one of the nurses.
She then exits back out to the reception area.
At 7:10 am S5Reg is seen in the patient reception desk area bending over towards the patient. Patient #2's father is seen stepping forward towards the interaction.
At 7:11 am S5Reg is seen returning to her desk and computer. Patient #2's father is seen picking Patient #2 back up and carrying him out of the reception desk area towards the front door.
At 7:11 am Patient #2's father exits the Emergency Department carrying Patient #2. S5Reg returns to the triage area as Patient #2's father exited the Emergency Department.

In an interview on 05/24/2023 at 12:30 p.m. S2VPNur stated Patient #2 was never registered on the Emergency Department Log at or around 7:07 a.m. on 05/14/2023.

Based on record review, video review and interview the hospital failed to provide an appropriate medical screening exam on all patients who presented to the emergency department with an emergency complaint for 1 (#2) of 21 (#1-21) patients sampled. This deficient practice is evidenced by Patient #2 presenting to the emergency department seeking medical treatment for breathing issues, being assessed by S5Reg and then leaving the emergency department without receiving a medical screening exam.

Findings:

A review of the hospital policy titled: EMTALA- Medical Screening Examination and Stabilization Policy reviewed 10/2021 revealed in part:
An EMTALA obligation is triggered when an individual comes to a dedicated emergency department (DED) and:
1. The individual or representative acting on the individual's behalf request an examination or treatment for a medical condition; or
2. A prudent layperson observer would conclude from the individual's appearance or behavior that the individual needs and examination or treatment of a medical condition.
Such obligation is further extended to those individuals presenting elsewhere on hospital property requesting examination or treatment for an emergency medical condition (EMC). Further, if a prudent layperson observer would believe that the individual is experiencing and EMC, then an appropriate MSE, within the capabilities of the hospital's DED (including ancillary services routinely available and the availability of on call physicians), shall be performed. The MSE must be completed by an individual (i) qualified to perform such an examination to determine whether an EMC exist, or (ii) with respect to a pregnant woman having contractions, whether the woman is in labor and whether the treatment requested is explicitly for an EMC.

A review of video footage from 05/14/2023 revealed:
At 7:07 in the morning, Patient #2's father enters the Emergency Department patient reception area. S5Reg is sitting at the reception desk and engages with the patient and his father. The child is sitting on the desk with his back to S5Reg while Patient #2's father appears to speak with S5Reg.
At 7:09 S5Reg gets up from her chair behind the reception desk. Patient #2's father is seen carrying Patient #2 behind the reception desk. S5Reg appears to engage with the patient while Patient #2's father stands back and watches.
At 7:10 S5Reg walks into the patient triage area leaving Patient #2 and his father waiting in the chairs behind the reception desk. Once in the nurse's triage area, S5Reg locates a stethoscope in the drawer next to one of the nurses.
She then exits back out to the reception area.
At 7:10 am S5Reg is seen in the patient reception desk area bending over towards the patient. Patient #2's father is seen stepping forward towards the interaction.
At 7:11 am S5Reg is seen returning to her desk and computer. Patient #2's father is seen picking Patient #2 back up and carrying him out of the reception desk area towards the front door.
At 7:11 am Patient #2's father exits the Emergency Department carrying Patient #2. S5Reg returns to the triage area as Patient #2's father exited the Emergency Department.

A review of the ED Central Log revealed Patient #2 returned to the ED on 05/14/2023 at 2:43 p.m. with a chief complaint of asthma.

A review of Patient #2's medical record from the second visit on 05/14/2023 at 2:43 p.m. revealed Patient #2 was diagnosed with pneumonia and transferred to a higher level of care.

In an interview on 05/24/2023 at 12:30 p.m. S2VPNur stated Patient #2 did not receive a medical screening exam on the first ED visit at or around 7:07 a.m. on 05/14/2023. S2VPNur also verified Patient #2 was transferred to a higher level of care on their return visit to the Emergency Department.