HospitalInspections.org

Based on Emergency Medical Treatment and Transfer Policy (EMTALA) policy review, Medical Screening Exam (MSE) policy, medical record review, and medical staff interviews the facility failed to follow their policy for 3 (Patient 7, P9 & P14) of 20 sampled Emergency Department (ED) patients. This failed practice has the potential to cause negative outcomes for all patients who present to the ED seeking emergent care and treatment. According to facility provided data the ED saw an average of 5,467 patients per month for the past 6 months.

See citation A2406 and A2407, that also resulted in A2400 to not be met.

Based on policy review, medical record review, medical staff interviews and administrative interviews the facility failed to ensure 2 (Patient 9 & P14) of 20 Emergency Department (ED) sampled patients were provided a complete Medical Screening Exam (MSE) to determine whether the presence of an Emergency Medical Condition (EMC) existed prior to patient disposition (final determination of the patients next level of care which includes discharge, admit, or transfer). P9 presented to the ED with a chief complaint of chest pain and waited to be roomed after triage for 3 hours before the patient left without being seen by a qualified medical professional to rule out an EMC. P14 was discharged from the facility's ED without a psychiatric evaluation. This failed practice has the potential to cause harm or death to patients who present to the ED with an EMC. According to facility provided data the ED saw an average of 5,467 patients per month for the past 6 months.

See citation A2400 and A2407, that also resulted in A2406 to not be met.

Findings include:

A. Review of facility Emergency Medical Treatment and Transfer policy, approved 8/2024 revealed:

A MSE is defined as the process required to reach with reasonable clinical confidence, the point at which it can be determined whether a medical emergency does or does not exist.

EMC is defined as a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate attention could reasonably be expected to result in placing the health of the individual in serious jeopardy.

A QMP is defined as individuals authorized to perform a MSE in accordance with the facility policy Medical Screening Exam.

Review of the facility Medical Screen Exam policy, approved 4/2023 revealed:

A medical exam performance eligibility criteria for the ED and the Psychiatric Emergency Services (PES) includes a licensed Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) who is a medical staff member or supervised house officer.

B. Review of P9's medical record revealed, P9 presented to the acute care hospital ED on 2/11/2025 at 5:35PM via walk in, with a chief complaint of chest pain, and triaged at 5:38PM for a Emergency Severity Index (ESI) of 3 (urgent level of priority for severity of a patient's injury or illness on a scale of 1-5, 1=highest priority and 5=non-urgent).

At 5:38PM, the triage nurse placed ED chest pain protocol orders for P9 which included but was not limited to:
-An intravenous (IV) (inserting a needle into a vein to give fluids or medication). P9's medical record lacked evidence of the IV being placed, confirmed by Registered Nurse (RN)-A.

-A high sensitivity troponin (a blood test that measures heart muscle damage.), collected at 6:31PM and resulted at 8:46PM. [3 hours after the order was placed with an expected result time of 1 hour after drawn, confirmed by Physician-A.]

At 5:43PM, P9 reported 10/10 middle upper chest pain with an onset of 20 minutes (the time symptoms started) prior to arrival that radiated (the pain moves to another location of the body) to the left chest and jaw, denied nausea/vomiting, and no precipitating emotional events to the triage nurse.

At 5:46PM, P9 was sent out to the lobby to wait for a room to be seen by a QMP for an MSE to rule out an EMC. P9 left the ED without being seen by a QMP at 8:20PM. P9 was called to room at 8:50PM (the staff says the patients name in the ED lobby to take them to a room to be seen by a QMP to provide an MSE to rule out or treat an EMC.)

P9's medical record lacked evidence of any repeat vitals, assessment or exam from a QMP prior to the patient leaving the ED 3 hours after arrival with a chief complaint of radiating chest pain.

Review of P14's medical record revealed, P14 presented to the acute care hospital ED on 11/18/2024 at 8:46PM via ambulance, with a chief complaint of altered mental status from a possible drug overdose. P14 medical record lacked evidence of a psychiatric evaluation prior to the 11/19/2024 discharge at 6:39AM, confirmed by Physician-A.

C. During an interview on 2/25/2025 at 11:36 AM, RN-B confirmed P9's medical record lacked evidence of any repeat vitals, assessment or exam from a QMP prior to the patient leaving the ED 3 hours after arrival with a chief complaint of radiating chest pain.

During an interview on 2/26/2025 at 11:41 AM, Physician-A confirmed P9's medical record lacked evidence of the high sensitivity troponin resulting within the 1 hour expected time frame, and any repeat vitals, assessment or exam from an RN or QMP prior to the patient leaving the ED 3 hours after arrival with a chief complaint of radiating chest pain.

During an interview on 2/26/2025 at 11:45 AM, Physician-A revealed a gap was identified with the psychiatric consult. P14's physicians shift ended at 12:24AM on 11/19/2024, and the oncoming physician thought the Licensed Mental Health Practitioner (LMHP) (a health professional who can assess, diagnose, and treat mental health) was notified to evaluate P14 prior to discharge. Physician-A confirmed P14 medical record lacked evidence of a psychiatric evaluation from an LMHP prior to the 11/19/2024 discharge at 6:39AM. The facility created a hard stop in the electronic medical record to require a note from the LMHP prior to disposition, and the ED physicians now call the consulting provider directly.

Based on policy review, medical record review and interviews the facility failed to ensure 2 (Patient 7 & P9) of 20 Emergency Department (ED) sampled patients were provided a timely medical screening exam (MSE) to rule out an Emergency Medical Condition (EMC) to determine if stabilizing treatment was required within 3 hours of initial presentation with chief complaints of an allergic reaction, and chest pain. The facility failed to monitor or reassess (the triage nurse reassess to ensure the triage level is still appropriate if the MSE is delayed) P7 and P9 while in the lobby waiting to be seen by a qualified medical personnel (QMP) for 3 hours. This failed practice has the potential to cause harm or death due to a delay in stabilizing treatment to all patients who present to the facility ED with an Emergency Medical Condition (EMC). According to facility provided data the ED saw an average of 5,467 patient per month for the past 6 months.

See citation A2400 and A2406, that also resulted in 2407 to not be met.

Findings include:

A. Review of facility Emergency Medical Treatment and Transfer policy, approved 8/2024 revealed:

A MSE is defined as the process required to reach with reasonable clinical confidence, the point at which it can be determined whether a medical emergency does or does not exist.

EMC is defined as a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate attention could reasonably be expected to result in placing the health of the individual in serious jeopardy.

A QMP is defined as individuals authorized to perform a MSE in accordance with the facility policy Medical Screening Exam.

Review of the facility Medical Screen Exam policy, approved 4/2023 revealed:

A medical exam performance eligibility criteria for the ED and the Psychiatric Emergency Services (PES) includes a licensed Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) who is a medical staff member or supervised house officer.

B. Review of P7's medical record revealed, P7 presented to the acute care hospital ED on 1/7/2025 at 8:17PM with a chief complaint of an allergic reaction with shortness of breath after taking a first dose of antibiotic (medication for an infection) at 6:30PM, symptoms of itchiness and throat closing up began 15 minutes later, P7 took two Benadryl (allergy medicine) but was still having trouble breathing prior to going to the ED.

P7 was triaged at 8:20PM for an Emergency Severity Index (ESI) of 3 (urgent level of priority for severity of a patient's injury or illness on a scale of 1-5, 1=highest priority and 5=non-urgent).

At 8:24PM, P7 was sent out to the lobby to wait for a room to be seen by a QMP for an MSE to rule out an EMC.

P7's medical record lacked evidence of any repeat vitals, assessment or exam from a QMP prior to the patient's MSE that started at 11:23PM [3 hours after arrival with a chief complaint of an allergic reaction.]

P7's MSE revealed complaints of throat tight and "not right" was given treatment for potential anaphylaxis (a severe life threatening allergic reaction that occurs when the body's immune system overreacts to an allergen) on 11/19/2024 at 12:18AM.

Review of P9's medical record revealed, P9 presented to the acute care hospital ED on 2/11/2025 at 5:35PM via walk in, with a chief complaint of chest pain, and triaged at 5:38PM for a Emergency Severity Index (ESI) of 3 (urgent level of priority for severity of a patient's injury or illness on a scale of 1-5, 1=highest priority and 5=non-urgent).

A high sensitivity troponin (a blood test that measures heart muscle damage.) was ordered at 5:38PM, collected at 6:31PM and resulted at 8:46PM. [3 hours after the order was placed with an expected result time of 1 hour after drawn, confirmed by Physician-A.]

C. During an interview on 2/26/2025 at 11:00 AM, Physician-A revealed that treatment does not define acuity (how serious a patient's medical condition is), P7 did not have any stridor or wheezing, if changes occurred then the patient severity would have been escalated and treated. Physician-A confirmed P7's medical record lacked evidence of any repeat vitals, assessment or exam from a QMP prior to the patient's MSE that started at 11:23 PM [3 hours after arrival with a chief complaint of an allergic reaction.]

During an interview on 2/26/2025 at 11:41 AM, Physician-A confirmed P9's medical record lacked evidence of the high sensitivity troponin resulting within the 1 hour expected time frame, and any repeat vitals, assessment or exam from an RN or QMP prior to the patient leaving the ED 3 hours after arrival with a chief complaint of radiating 10/10 chest pain (highest level of pain that moves from the chest to another location).