HospitalInspections.org

Based on review of hospital policy and procedure, medical records (MR), video footage, and interviews with staff, it was determined the hospital failed to:

Provide an appropriate medical screening examination within the capability of the hospital's Emergency Department (ED) for one of 12 MRs reviewed who presented to the ED with psychiatric complaints of Suicidal Ideations including Patient Identifier (PI) # 1.

This deficient finding had the potential to negatively affect all patients served by the hospital ED.

Findings include:

Refer to A2406.

Based on Medical Record (MR) review, hospital policy and procedure, staff interviews, video surveillance footage, Emergency Department (ED) bed census and staffing, it was determined the hospital failed to ensure that a medical screening examination (MSE) was provided that was within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition existed on a patient who presented to the ED for Suicidal Ideations (SI).

This affected Patient Identifier (PI) # 1, one of 12 MRs reviewed who presented to the ED with psychiatric complaints and had the potential to negatively affect all patients seeking treatment for psychiatric illnesses.

Findings Include:

Hospital Policy: DCH (Druid City Hospital) Emergency Department
Statement on "EMTALA"
Emergency Medical Treatment and Active Labor Act
Policy Number: None
Date Revised: October 2024

... Medical Screening Examinations:

DCH hospitals must provide an MSE to any individual to which the obligations of EMTALA apply... :

The purpose of the MSE is to determine the existence or absence of an EMC. The scope of the MSE must be sufficient, based on individual circumstances, to accomplish this purpose.

EMC:

... A psychiatric patient with the following conditions, as determined by a physician, is considered to have an EMC (Emergency Medical Condition):

... Expresses suicidal thoughts or gestures...

Determining Competence to Make Informed Decision:

... If an individual presents to the ED and is complaining of or appears to be suffering from
A psychiatric or psychotic condition(s)...
He/she should not be allowed to leave the hospital without examination or treatment until it is determined that he/she is legally competent to make such a decision...

Hospital Policy: Triage Guidelines
Policy Number: None
Date Adopted: 4/2024

I. Purpose:

The purpose of triage is to prioritize incoming patients and identify those patients who cannot wait to be seen...

II. Policy:

A. Every patient will have an initial screen (chief complaint, vital signs, and visual observation) followed by a triage assessment of their physical and psychosocial problems by a Registered Nurse (RN)...

III. Procedure:

A. Triage Assessment:

The purpose of triage in the emergency department is to prioritize incoming patients and to identify those who cannot wait to be seen... The triage nurse will assign the patient a triage acuity level, which is a proxy measure of how long an individual patient can safely wait for an MSE and treatment... the triage nurse may take the patient to an appropriate treatment area or have the patient return to the waiting area until a room is available...

B. Ongoing Monitoring of Triage Patients:

...2. Vital sign measurements, as well as visual monitoring while interacting with the patient, will take place every two hours or more frequently as indicated.

C. Patients Who Leave without Being Seen:

1. If the triage nurse is notified about the patient's wish to leave prior to seeing a provider, the nurse should take the opportunity to discuss the situation with the patient and encourage him/her to stay. If the patient chooses to leave after talking with the triage nurse, the triage nurse should notify the ED provider...

2. If a patient walks out of the department without notifying staff, the nurse will document the time it was first noted that the patient was no longer in the ED. Also, the nurse will document efforts to locate the patient...

Hospital Policy: Suicide Risk Assessment/Suicide Precautions
Policy Number: None
Date Revised November 14, 2024

I. Purpose:

A. To provide a mechanism to screen and assess a patient's suicidal risk in a non-behavioral unit.

B. To provide the patient who has been identified at high risk for suicide with an environment that is as safe as possible. To protect the patient from him/herself until the physician states that the suicidal crisis is passed and discontinues the order, or the patient is moved to a more secure environment...

II. Policy:

A suicide risk screen is performed on all patients... triaged in the ED...

1. PI # 1 presented to the ED on 12/14/24 at 7:42 PM with a stated complaint of suicide and do not feel safe at home.

Review of the MR and video surveillance revealed the patient arrived on 12/14/24 at 7:42 PM and left on 12/15/24 at 1:19 AM.

Review of the documentation by the nurse dated 12/15/24 at 1:49 AM revealed, "Patient called 911 from (the) lobby. (Name) PD (Police Department) responded without nursing staff knowledge. PD contacted (EMS Emergency Medical Services) to transfer (the) patient to BMU (Behavioral Medical Unit)."

Further review of the MR revealed there was no documentation the patient received triage or a MSE.

Review of the ED Discharge documentation revealed the patient left before triage.

A phone interview was conducted on 12/19/24 at 9:01 AM with EI # 3, ED registered nurse (RN), who confirmed PI # 1 was not triaged.

An interview conducted on 12/19/24 at 2:30 PM with EI # 4, ED physician revealed the ED physician was not made aware there was a patient in the ED with SI and a MSE was not performed.

An interview was conducted on 12/20/24 at 2:28 PM with EI # 5, Systems Director of Emergency Services, who confirmed the hospital failed to perform a MSE on PI#1.

The facility failed to ensure that their policy and procedures were followed as evidenced by failing to provide a MSE within the capability of the hospital's ED to determine whether or not an emergency medical condition existed for patient #1 on 12/14/2024. Patient #1 presented to the hospital's ED expressing suicidal ideations and was allowed to leave the hospital's ED without receiving examination or treatment until it was determined he was legally competent to make such decisions as stated in the hospital's policy and procedure.