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Based on review of policies and procedures, hospital documents, clinical records, and staff interviews, it was determined the hospital failed to enforce policies and procedures that comply with the requirements of 42CFR §489.20 and 42 CFR §489.24, responsibilities of Medicare participating hospitals in emergency cases.

Findings include:

1. The policy titled " St Mary's Hospital, Triage, Assessment and RE-Assessment, Effective date 5/22/03, Last review date 8/2021 " requires: " ... ' Quick Look ' and comprehensive triage are assessments that include a rapid and systematic collection of data relevant to each patient ' s chief complaint, age, cognitive level, and social situation. The assessment is conducted to obtain sufficient information to determine patient acuity and any immediate physical or psychosocial needs ... Triage facilitates the flow of patients through the emergency care system, ensuring a timely evaluation and plan of care based on the health care needs of the patient ...Based on EMTALA policy, all patients who come to the ED seeking health care will be: ...Offered a Medical Screening Exam (MSE) ...Registered into the CHN System ...Triage ...Every patient will be sorted and classified according to urgency of condition or complaint. Triage is the first decision point in the care of the emergency patient ...a) Quick-Look Triage: refers to a rapid assessment that assures ABCs are intact and the patient does not have a life-threatening or potentially life- threatening illness or injury ...b) Comprehensive Triage: refers to a focused assessment based on chief complaint and presenting signs and symptoms and urgency of care needed ...The triage assessment is done by a registered nurse (RN). All other members of the health care team will contribute to the gathering of information and formulation of the plan of care.

Review of Patients #1 - 25's ED medical records revealed that the facility failed to provide either a "quick look" or comprehensive RN triage assessment for (11) of (25) patients (Patients #1, 3, 9, 10, 11, 12, 13, 16, 17, 19, and 20) that presented to the ED seeking care for an emergency medical condition.

Employees #2 and 6 confirmed on 08/12/2024 that the staff did not follow facility policy for providing nursing "quick look" and/or comprehensive triage assessments for the 11 aforementioned patients.

2. The policy titled "Carondelet Health Network, Emergency Medical Treatment and Labor Act of 1986 (EMTALA), Effective Date: 12/13/2021" requires: "...Purpose: To ensure individuals presenting to [Carondelet Hospital ' s] emergency department receive an appropriate Medical Screening Examination (MSE) and stabilizing treatment or an appropriate transfer in accordance with and that requests for transfer to [Carondelet Hospitals] are accepted or declined in accordance with the Emergency Medical Treatment and Labor Act of 1986 (EMTALA) ... III. Definitions: ... Emergency Medical Condition: A condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs ...Medical Screening Examination (MSE): Screening process required to determine with reasonable clinical confidence whether an emergency medical condition does or does not exist ...A.[Carondelet Hospitals] will provide an appropriate MSE within the capability of Carondelet Hospital] to any individual coming to the Dedicated Emergency Department, including ancillary services routinely available, to determine whether or not an Emergency Medical Condition exists ...B. Subject to the patient ' s right to refuse treatment, [Carondelet Hospitals] will provide an individual who is determined to have an Emergency Medical Condition further medical examination and treatment as is required to stabilize the Emergency Medical Condition, including admission for inpatient care, or arrange an appropriate transfer of the individual to another medical facility with the Capability to provide the stabilizing care .... "

Review of Patients #1 - 25's ED medical records revealed that the facility failed to provide MSE's for

Employees #2 and 6 confirmed on 08/12/2024 that providers did not conduct an MSE for (18) of (25) patients (Patients #1, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 22, 23 and 25) that presented to the ED for examination and treatment.

3. The policy titled "St. Mary's Hospital, Leaving Against medical Advice, Effective date November 2003, Last review Dec 2018" requires: " ...Against Medical Advice, (AMA). The self-discharge of a patient from a health care facility, contrary to what the patient ' s physician(s) perceive to be in the patient ' s best interests after assessment and treatment has been recommended. The patient is asked to sign a form, acknowledging that they are aware of the risks associated with leaving the medical facility before treatment has been completed. Elopement is a term used when a patient leaves the treatment setting without notification to the nursing unit or before the Medical Screening Exam (MSE) in the Emergency Department. See related policy on Emergency Medical Treatment and Active Labor Act (EMTALA). Left without being seen or left without treatment is a term used to describe a situation in the Emergency Department when the patient voluntarily left without being triaged and/or receiving a medical screening examination ... Documentation of AMA and elopement situations is the responsibility of the physicians and nursing staff ...ELOPEMENT: If it is determined that a Category #1 Patient left the medical facility without notifying anyone (see definition of " Elopement " above), this should be recorded in the medical record and the patient ' s physician must be notified. (See the EMTALA policy for guidelines on how to document if a patient leaves the Emergency Department prior to receiving a Medical Screening Exam or prior to being seen.) ...The following information should be documented in the medical record: 1. Time/location patient found missing or left AMA. 2. Steps taken, if applicable, to locate the patient, including who was notified and when and where search was conducted. 3. If patient is found, where found and patient ' s condition. 4. Any follow-up care for a patient that is found and who was notified .... "

Review of Patients #1 - 25's ED medical records revealed that the facility failed to ensure appropriate information was documented by staff in (18) of (25) patients' medical records (Patients #1, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, and 22) as required by policy for leaving without treatment.

Additionally, the policy titled "St. Mary's Hospital, Leaving Against medical Advice, Effective date November 2003, Last review Dec 2018" referenced guidelines to be found in the EMTALA policy for documentation of AMA and elopement; however, the EMTALA policy did not include guidelines for the documentation requirements.

Employee #2 confirmed on 02/12/2024 that facility staff and providers did not document as required patients' that eloped or left without treatment.

Based on document review and interview, it was determined that the facility failed to complete a medical screening examination (MSE) to determine if an emergency medical condition existed and provide treatment and/or at a minimum provide an RN triage assessment of patients' condition upon arrival to ensure that the patients were appropriately prioritized based on presenting condition if the provider was unable to immediately complete an appropriate examination. This deficient practice poses a risk to the health and safety of patients if life-threatening or potentially life threatening conditions are not recognized and stabilizing treatment provided.

Findings include:

The policy titled "Carondelet Health Network, Emergency Medical Treatment and Labor Act of 1986 (EMTALA), Effective Date: 12/13/2021" requires: "...Purpose: To ensure individuals presenting to [Carondelet Hospital ' s] emergency department receive an appropriate Medical Screening Examination (MSE) and stabilizing treatment or an appropriate transfer in accordance with and that requests for transfer to [Carondelet Hospitals] are accepted or declined in accordance with the Emergency Medical Treatment and Labor Act of 1986 (EMTALA) ... III. Definitions: ... Emergency Medical Condition: A condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs ...Medical Screening Examination (MSE): Screening process required to determine with reasonable clinical confidence whether an emergency medical condition does or does not exist ...A.[Carondelet Hospitals] will provide an appropriate MSE within the capability of Carondelet Hospital] to any individual coming to the Dedicated Emergency Department, including ancillary services routinely available, to determine whether or not an Emergency Medical Condition exists ...B. Subject to the patient ' s right to refuse treatment, [Carondelet Hospitals] will provide an individual who is determined to have an Emergency Medical Condition further medical examination and treatment as is required to stabilize the Emergency Medical Condition, including admission for inpatient care, or arrange an appropriate transfer of the individual to another medical facility with the Capability to provide the stabilizing care .... "

The policy titled " St Mary's Hospital, Triage, Assessment and RE-Assessment, Effective date 5/22/03, Last review date 8/2021 " requires: " ... ' Quick Look ' and comprehensive triage are assessments that include a rapid and systematic collection of data relevant to each patient ' s chief complaint, age, cognitive level, and social situation. The assessment is conducted to obtain sufficient information to determine patient acuity and any immediate physical or psychosocial needs ... Triage facilitates the flow of patients through the emergency care system, ensuring a timely evaluation and plan of care based on the health care needs of the patient ...Based on EMTALA policy, all patients who come to the ED seeking health care will be: ...Offered a Medical Screening Exam (MSE) ...Registered into the CHN System ...Triage ...Every patient will be sorted and classified according to urgency of condition or complaint. Triage is the first decision point in the care of the emergency patient ...a) Quick-Look Triage: refers to a rapid assessment that assures ABCs are intact and the patient does not have a life-threatening or potentially life- threatening illness or injury ...b) Comprehensive Triage: refers to a focused assessment based on chief complaint and presenting signs and symptoms and urgency of care needed ...The triage assessment is done by a registered nurse (RN). All other members of the health care team will contribute to the gathering of information and formulation of the plan of care.

The policy titled " The policy titled " St. Mary's Hospital, Leaving Against medical Advice, Effective date November 2003, Last review Dec 2018 " requires: " ...Against Medical Advice, (AMA). The self-discharge of a patient from a health care facility, contrary to what the patient ' s physician(s) perceive to be in the patient ' s best interests after assessment and treatment has been recommended. The patient is asked to sign a form, acknowledging that they are aware of the risks associated with leaving the medical facility before treatment has been completed. Elopement is a term used when a patient leaves the treatment setting without notification to the nursing unit or before the Medical Screening Exam (MSE) in the Emergency Department. See related policy on Emergency Medical Treatment and Active Labor Act (EMTALA). Left without being seen or left without treatment is a term used to describe a situation in the Emergency Department when the patient voluntarily left without being triaged and/or receiving a medical screening examination ... Documentation of AMA and elopement situations is the responsibility of the physicians and nursing staff ...ELOPEMENT: If it is determined that a Category #1 Patient left the medical facility without notifying anyone (see definition of " Elopement " above), this should be recorded in the medical record and the patient ' s physician must be notified. (See the EMTALA policy for guidelines on how to document if a patient leaves the Emergency Department prior to receiving a Medical Screening Exam or prior to being seen.) ...The following information should be documented in the medical record: 1. Time/location patient found missing or left AMA. 2. Steps taken, if applicable, to locate the patient, including who was notified and when and where search was conducted. 3. If patient is found, where found and patient ' s condition. 4. Any follow-up care for a patient that is found and who was notified .... "

Patient #1 presented to an urgent care prior to seeking treatment at Hospital #1. The urgent care provider recommended the patient go to an ED for treatment after evaluating the patient.

The ED log dated 01/10/2024 revealed that Patient #1 presented to Hospital #1 ' s ED on 01/10/2024 at 1636 with dyspnea and that the patient " left without being seen " on 01/10/2024 at 1728.

Patient #1 ' s medical record contained a face sheet with the patient ' s demographic information, an ED nursing note entered on 01/10/2024 at 2041 for 1728 that revealed: " ...pt (sic) not found in lobby when called to triage. pt (sic) not seen by staff at front desk or ed (sic) leaving ... " The provider ED note dated 01/10/2024 at 1813 revealed: " ...This patient left prior to evaluation. I did not have the opportunity to evaluate him .... "

Patient #1 ' s medical record from Hospital #2 revealed that the patient presented the second ED and was registered on 01/10/2024 at 1804. Patient #1 was triaged by an RN at 1811 and an MSE initiated by the provider at 2037 and diagnostic testing and treatment was initiated. Patient #1 was diagnosed with rhinovirus associated respiratory insufficiency with hypoxia and sepsis and subsequently admitted as an inpatient to Hospital #2 for treatment.

Review of an additional 24 patient ED records revealed a pattern of lack of timely RN triage to determine the severity of the patients ' presenting symptoms, ensure airway, breathing and circulation were intact, or that patients presenting with life threatening or potentially life-threatening conditions were promptly seen by a provider for an MSE and/or stabilizing treatment. Additionally, the additional 24 patient records revealed a pattern of delay in an MSE by the provider.

Medical records for (17) of (24) patients (Patients #3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, and 22) revealed the following:

Patient #3 - Patient registered on 01/10/2024 at 2004 with complaint of a toothache. No triage or MSE was performed for the patient and the patient left without being seen at 2030. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #5 - Patient registered on 01/01/2024 at 1558 with complaint of an allergic reaction. The RN triaged the patient at 1836 (2 hours 38 minutes after presentation to the ED). The ED provider did not conduct an MSE. The ED provider made a note on 01/02/2024 at 0711 that an MSE was not conducted because the patient left the ED. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #6 - Patient registered on 01/04/2024 at 1603 with complaint of flank pain. The RN triaged the patient at 1715 (1 hour 12 minutes after presentation to the ED). The ED provider did not conduct an MSE. The medical record revealed that the patient was missing from the ED lobby on 01/07/2024 at 0252. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #7 - Patient registered on 01/05/2024 at 1717 with complaint of abdominal pain. The RN triaged the patient at 1730. The ED provider did not conduct an MSE. There were no provider ED notes as to the reason an MSE was not conducted. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #8 - Patient registered on 01/05/20245 at 1744 with complaint of stepping on rusty nail. The RN triaged the patient at 1840 (56 minutes after presentation to the ED). The ED provider did not conduct an MSE. There were no provider ED notes as to the reason an MSE was not conducted. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #9 - Patient registered on 01/16/2024 at 1734 with complaint of abdominal pain. No triage or MSE was conducted for the patient as of 2029 when the patient was noted to be missing from the lobby by the RN attempting to triage the patient (2 hours 55 minutes after presentation to the ED). The ED log discharge disposition revealed "Left Without Being Seen."

Patient #10 - Patient registered on 01/19/2024 at 1243 with complaint of leg bleeding. The record only contained a face sheet and did not contain any progress notes. The RN did not triage the patient or enter a nursing note to document a disposition. The MD did not conduct an MSE or document why an MSE was not conducted. The patient was discharged at 1414 (1 hour 31 minutes after presenting for emergency medical care). The ED log discharge disposition revealed "Left Without Being Seen."

Patient #11 - Patient registered on 01/19/2024 at 1304 with complaint of dizziness. No triage or MSE was performed for the patient. The patient was missing form the facility when the RN went to lobby to triage at 1436 (1 hour 32 minutes after presentation to the ED). The ED log discharge disposition revealed "Left Without Being Seen."

Patient #12 - Patient registered on 01/25/2024 at 1232 with complaint of cough, wheezing. No triage or MSE was performed for the patient. The patient was found missing when the RN went to the lobby to triage the patient at 1419 (1 hour 47 minutes after presentation to the ED). The MD made a note that no MSE was done and documented a call to the patient in which the patient reported they sought treatment at another facility. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #13 - Patient registered on 02/08/2024 at 1458 with complaint of dislocated jaw. No triage or MSE was performed for the patient. The RN did not complete any notes or a reason why the patient was not triaged. The MD did not conduct an MSE and made a note that the patient left prior to triage. The patient was discharged at 1610 (1 hour 48 minutes after presentation to the ED). The ED log discharge disposition revealed "Left Without Being Seen."

Patient #15 - Patient registered on 02/20/2024 at 1403 with complaints of fever, rash, and abdominal pain. The RN triaged the patient at 1431. The RN made a note at 2048 that the patient left the ED because they were tired of waiting to see a provider for MSE. The patient was discharged at 2048 (6 hours 45 minutes after presentation to the ED). The ED log discharge disposition revealed "Left Without Being Seen."

Patient #16 - Patient registered on 02/20/2024 at 1520 with complaint of abdominal pain. No triage or MSE was performed for the patient. The RN documented a note that triage was attempted at 1655 (1 hour 35 minutes after presentation to the ED). The MD made a note that MSE was not conducted and an attempt to call the patient's family on 02/21/2024 at 0844. The patient was discharged at 1728. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #17 - Patient registered on 02/20/2024 at 1527 with complaint of abdominal pain. No triage or MSE was performed for the patient. The RN documented that triage was not attempted until 1700 (1 hour 33 minutes after presentation to the ED). The MD did not conduct and MSE or make a note as to the patient's disposition. The patient was discharged at 1729. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #18 - Patient registered on 02/20/2024 at 1736 with complaint of shortness of breath, cough. The RN triaged the patient at 1805. The patient was not present in the lobby when called back for MSE at 2000. The MD contacted the patient by phone who stated that they will seek treatment elsewhere. The patient was discharged at 2005. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #19 - Patient registered on 02/25/2024 at 1407 with complaint of cough. No triage or MSE done. The RN made a note when triage was attempted at 1553 (1 hour 44 minutes after patient presented to the ED) that the patient had left. The MD made a note that triage and MSE were not done and a call to the patient's family revealed that they took the patient to another facility for treatment. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #20 - Patient registered on 12/26/2023 at 1322 with complaint of shortness of breath. The RN did not triage the patient or write a note why triage was not conducted. The MD made a not at 1733 that an MSE was not conducted because the patient had left the facility. The ED log discharge disposition revealed "Left Without Being Seen."

Patient #22 - Patient registered on 01/08/2024 at 2022 with complaints of shortness of breath and brought in by ambulance. The RN triaged the patient at 2025. The RN made a note in the record that the patient was noted as missing when passing by the patient's room at 2148. An MSE was not conducted and the patient was discharged at 2148. The ED log discharge disposition revealed "Left Without Being Seen."

Employee #2 confirmed on 08/08/2024 and 08/12/2024 that the aforementioned patients left the ED without treatment because they did not have an RN do triage assessment and/or have a provider perform an MSE within an appropriate timeframe.

Employees #2 and 6 confirmed on 08/12/2024 that the goal for the facility was to have an RN triage assessment within 15 minutes or less and an MSE by a qualified medical provider within 30 minutes or less and that this was not done for the aforementioned patients.

Based on record reviews and staff interviews, it was determined the Hospital delayed examination and treatment for (20) of (25) patients (Patients #1, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, 22, 23 and 25) who presented to the ED seeking medical treatment. Failure to provide timely medical examination and treatment poses a potential risk that a patient is denied necessary medical treatment.

Findings include:

The policy titled "Carondelet Health Network, Emergency Medical Treatment and Labor Act of 1986 (EMTALA), Effective Date: 12/13/2021" requires: "...Purpose: To ensure individuals presenting to [Carondelet Hospital ' s] emergency department receive an appropriate Medical Screening Examination (MSE) and stabilizing treatment or an appropriate transfer in accordance with and that requests for transfer to [Carondelet Hospitals] are accepted or declined in accordance with the Emergency Medical Treatment and Labor Act of 1986 (EMTALA) ... III. Definitions: ... Emergency Medical Condition: A condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs ...Medical Screening Examination (MSE): Screening process required to determine with reasonable clinical confidence whether an emergency medical condition does or does not exist ...A.[Carondelet Hospitals] will provide an appropriate MSE within the capability of Carondelet Hospital] to any individual coming to the Dedicated Emergency Department, including ancillary services routinely available, to determine whether or not an Emergency Medical Condition exists ...B. Subject to the patient ' s right to refuse treatment, [Carondelet Hospitals] will provide an individual who is determined to have an Emergency Medical Condition further medical examination and treatment as is required to stabilize the Emergency Medical Condition, including admission for inpatient care, or arrange an appropriate transfer of the individual to another medical facility with the Capability to provide the stabilizing care .... "

The policy titled " St Mary's Hospital, Triage, Assessment and RE-Assessment, Effective date 5/22/03, Last review date 8/2021 " requires: " ... ' Quick Look ' and comprehensive triage are assessments that include a rapid and systematic collection of data relevant to each patient ' s chief complaint, age, cognitive level, and social situation. The assessment is conducted to obtain sufficient information to determine patient acuity and any immediate physical or psychosocial needs ... Triage facilitates the flow of patients through the emergency care system, ensuring a timely evaluation and plan of care based on the health care needs of the patient ...Based on EMTALA policy, all patients who come to the ED seeking health care will be: ...Offered a Medical Screening Exam (MSE) ...Registered into the CHN System ...Triage ...Every patient will be sorted and classified according to urgency of condition or complaint. Triage is the first decision point in the care of the emergency patient ...a) Quick-Look Triage: refers to a rapid assessment that assures ABCs are intact and the patient does not have a life-threatening or potentially life- threatening illness or injury ...b) Comprehensive Triage: refers to a focused assessment based on chief complaint and presenting signs and symptoms and urgency of care needed ...The triage assessment is done by a registered nurse (RN). All other members of the health care team will contribute to the gathering of information and formulation of the plan of care.

Patient #1 presented to an urgent care prior to seeking treatment at Hospital #1. The urgent care provider recommended the patient go to an ED for treatment after evaluating the patient.

The ED log dated 01/10/2024 revealed that Patient #1 presented to Hospital #1 ' s ED on 01/10/2024 at 1636 with dyspnea and that the patient " left without being seen " on 01/10/2024 at 1728.

Patient #1 ' s medical record contained a face sheet with the patient ' s demographic information, an ED nursing note entered on 01/10/2024 at 2041 for 1728 that revealed: " ...pt (sic) not found in lobby when called to triage. pt (sic) not seen by staff at front desk or ed (sic) leaving ... " The provider ED note dated 01/10/2024 at 1813 revealed: " ...This patient left prior to evaluation. I did not have the opportunity to evaluate him .... " The RN did not attempt to triage Patient #1 until 1728 (52 minutes after the patient's arrival at the ED seeking treatment).

Patient #1 ' s medical record from Hospital #2 revealed that the patient presented the second ED and was registered on 01/10/2024 at 1804. Patient #1 was triaged by an RN at 1811 and an MSE initiated by the provider at 2037 and diagnostic testing and treatment was initiated. Patient #1 was diagnosed with rhinovirus associated respiratory insufficiency with hypoxia and sepsis and subsequently admitted as an inpatient to Hospital #2 for treatment.

Review of an additional 24 patient ED records revealed a pattern of lack of timely RN triage to determine the severity of the patients ' presenting symptoms, ensure airway, breathing and circulation were intact, or that patients presenting with life threatening or potentially life-threatening conditions were promptly seen by a provider for an MSE and/or stabilizing treatment. Additionally, the additional 24 patient records revealed a pattern of delay in an MSE by the provider.

Medical records for (17) of (24) patients (Patients #3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20, and 22) revealed the following:

Patient #3 - Patient registered on 01/10/2024 at 2004 with complaint of a toothache. No triage or MSE was performed for the patient and the patient left without being seen at 2030. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #5 - Patient registered on 01/01/2024 at 1558 with complaint of an allergic reaction. The RN triaged the patient at 1836 (2 hours 38 minutes after presentation to the ED). The ED provider did not conduct an MSE. The ED provider made a note on 01/02/2024 at 0711 that an MSE was not conducted because the patient left the ED. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #6 - Patient registered on 01/04/2024 at 1603 with complaint of flank pain. The RN triaged the patient at 1715 (1 hour 12 minutes after presentation to the ED). The ED provider did not conduct an MSE. The medical record revealed that the patient was missing from the ED lobby on 01/07/2024 at 0252. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #7 - Patient registered on 01/05/2024 at 1717 with complaint of abdominal pain. The RN triaged the patient at 1730. The ED provider did not conduct an MSE. There were no provider ED notes as to the reason an MSE was not conducted. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #8 - Patient registered on 01/05/20245 at 1744 with complaint of stepping on rusty nail. The RN triaged the patient at 1840 (56 minutes after presentation to the ED). The ED provider did not conduct an MSE. There were no provider ED notes as to the reason an MSE was not conducted. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #9 - Patient registered on 01/16/2024 at 1734 with complaint of abdominal pain. No triage or MSE was conducted for the patient as of 2029 when the patient was noted to be missing from the lobby by the RN attempting to triage the patient (2 hours 55 minutes after presentation to the ED). The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #10 - Patient registered on 01/19/2024 at 1243 with complaint of leg bleeding. The record only contained a face sheet and did not contain any progress notes. The RN did not triage the patient or enter a nursing note to document a disposition. The MD did not conduct an MSE or document why an MSE was not conducted. The patient was discharged at 1414 (1 hour 31 minutes after presenting for emergency medical care). The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #11 - Patient registered on 01/19/2024 at 1304 with complaint of dizziness. No triage or MSE was performed for the patient. The patient was missing form the facility when the RN went to lobby to triage at 1436 (1 hour 32 minutes after presentation to the ED). The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #12 - Patient registered on 01/25/2024 at 1232 with complaint of cough, wheezing. No triage or MSE was performed for the patient. The patient was found missing when the RN went to the lobby to triage the patient at 1419 (1 hour 47 minutes after presentation to the ED). The MD made a note that no MSE was done and documented a call to the patient in which the patient reported they sought treatment at another facility. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #13 - Patient registered on 02/08/2024 at 1458 with complaint of dislocated jaw. No triage or MSE was performed for the patient. The RN did not complete any notes or a reason why the patient was not triaged. The MD did not conduct an MSE and made a note that the patient left prior to triage. The patient was discharged at 1610 (1 hour 48 minutes after presentation to the ED). The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #15 - Patient registered on 02/20/2024 at 1403 with complaints of fever, rash, and abdominal pain. The RN triaged the patient at 1431. The RN made a note at 2048 that the patient left the ED because they were tired of waiting to see a provider for MSE. The patient was discharged at 2048 (6 hours 45 minutes after presentation to the ED). The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #16 - Patient registered on 02/20/2024 at 1520 with complaint of abdominal pain. No triage or MSE was performed for the patient. The RN documented a note that triage was attempted at 1655 (1 hour 35 minutes after presentation to the ED). The MD made a note that MSE was not conducted and an attempt to call the patient ' s family on 02/21/2024 at 0844. The patient was discharged at 1728. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #17 - Patient registered on 02/20/2024 at 1527 with complaint of abdominal pain. No triage or MSE was performed for the patient. The RN documented that triage was not attempted until 1700 (1 hour 33 minutes after presentation to the ED). The MD did not conduct and MSE or make a note as to the patient ' s disposition. The patient was discharged at 1729. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #18 - Patient registered on 02/20/2024 at 1736 with complaint of shortness of breath, cough. The RN triaged the patient at 1805. The patient was not present in the lobby when called back for MSE at 2000. The MD contacted the patient by phone who stated that they will seek treatment elsewhere. The patient was discharged at 2005. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #19 - Patient registered on 02/25/2024 at 1407 with complaint of cough. No triage or MSE done. The RN made a note when triage was attempted at 1553 (1 hour 44 minutes after patient presented to the ED) that the patient had left. The MD made a note that triage and MSE were not done and a call to the patient ' s family revealed that they took the patient to another facility for treatment. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #20 - Patient registered on 12/26/2023 at 1322 with complaint of shortness of breath. The RN did not triage the patient or write a note why triage was not conducted. The MD made a not at 1733 that an MSE was not conducted because the patient had left the facility. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #22 - Patient registered on 01/08/2024 at 2022 with complaints of shortness of breath and brought in by ambulance. The RN triaged the patient at 2025. The RN made a note in the record that the patient was noted as missing when passing by the patient ' s room at 2148. An MSE was not conducted and the patient was discharged at 2148. The ED log discharge disposition revealed " Left Without Being Seen. "

Patient #23 - Patient registered on 01/09/2024 at 1820 with complaint of motor vehicle accident and right knee pain. The RN triaged the patient at 1938 (1 hour 18 minutes after presentation to the ED). An MSE was conducted at 2014 (1 hour 54 minutes after presentation to the ED). Both the RN triage assessment to determine the severity of the patient's condition as well as the MSE to determine if an emergency medical condition existed and treatment were delayed.

Patient #25 - Patient registered on 01/12/2024 at 1116 with complaint of shortness of breath. The RN triaged the patient at 1135. The provider conducted an MSE at 1437 (3 hours 21 minutes after presentation to the ED). There was a delay in the MSE to determine if an emergency medical condition existed and initiation of treatment.

Employee #2 confirmed on 08/08/2024 and 08/12/2024 that the aforementioned patients left the ED without treatment because there was a delay in RN triage assessment and/or MSE.

Employees #2 and 6 confirmed on 08/12/2024 that the goal for the facility was to have an RN triage assessment within 15 minutes or less and an MSE by a qualified medical provider within 30 minutes or less and that this was not done for the aforementioned patients.