HospitalInspections.org

Based on observation, interviews and record reviews, this hospital failed to ensure they were in complaisance with all EMTALA requirements under 42 CFR 489. The facility failed properly log all patients seeking treatment at this facilities emergency department in 1 of 20 (#1) patients; failed to provide a medical screening examination by a qualified individual prior to instructing the patient to seek treatment at another hospital in 1 of 20 patients (#1); and failed to post EMTALA signage in 1 of 2 areas emergency patients are triaged and examined (obstetrics unit). This deficient practice has the potential to affect all Obstetric patients seeking emergency medical treatment at this facility.

Findings include:

1) Observations during tour of the obstetrics department revealed no EMTALA signage in the treatment rooms or waiting rooms. Per facility policy all obstetrics patients greater than 20 weeks gestation receive emergency medical screening and triage in the obstetrics department. (See tag 2402)

2) Patient #1 came into the Emergency department seeking treatment on 5/11/16 at 4:06 AM. This facility failed to register and track the care of this patient in their emergency treatment central log and registration system. (See Tag 2405)

3) Patient #1 did not receive a medical screening exam prior to being asked to go to another facility for treatment. (See Tag 2406)

Based on observation, interview and record review, the facility failed to ensure EMTALA signs are posted in all waiting areas for emergency treatment in 1 of 2 observations (Obstetrics unit). This deficiency potentially affects all Emergency Department patients treated at this facility's Obstetrics floor. This deficient practice has the potential to affect all Obstetric patients seeking emergency medical treatment at this facility.

Findings include:

On 5/17/16 at 10:35 AM, the facility policy titled "Care of the Pregnant Patient in the Emergency Department" dated 7/21/2015 was reviewed. This policy states "Patients who are 20 or more weeks gestation with symptoms of an obstetrics related problem will be admitted directly to the BirthPlace unit. Specific symptoms include but may not be limited to: A. Vaginal bleeding, B. Uterine cramping/contractions C. Abdominal or pelvic pain, pressure or cramping, D. low back pain or pressure. E. Urinary symptoms. F. Suspected ruptured membranes..."

On 5/17/16 at 1:50 PM, observed no EMTALA signage was in the Obstetrics department (BirthPlace unit) while accompanied by Women and Families Manager M.

An interview was conducted with Women and Families Manager M on 5/17/16 at 1:50 PM, at the time of the observation. Manager M stated the Obstetrics department does not have a designated Emergency room for Obstetrics patients. Patients would be admitted and examined in an available room. Manager M stated there are no EMTALA signs on the Obstetrics floor.

Based on observation, record review and interview, the facility failed to register all individuals in central log who came to the emergency department seeking care, in 1 of 20 Emergency Department (ED) patients (Patient #1). This deficient practice has the potential to affect all patients seeking emergency medical treatment at this facility.

Findings include:

Observation of the video recording of patient (Pt) #1 at ED registration area, accompanied by President A and Risk Management Specialist B on 5/17/16 at 9:50 AM revealed: at 4:06 AM patient #1 arrives at registration via wheelchair, 4:07 AM approached by person identified as Registered Nurse (RN) C and ED technician D, 4:09 AM patient #1 goes into registrar area, 4:11 AM patient #1 leaves through waiting room via wheelchair.

On 5/17/16 at 10:00 AM, an interview was conducted with Registrar D. Registrar D stated "I was with another Obstetrics patient when the patient (#1) arrived. I asked them if they needed the ED when I seen them come around the corner. They said yes and I called (RN C) in the ER and (RN C) and (ED technician D) came out. The patient told (RN C) her water broke and (RN C) asked if she needed to push." Registrar D had finished with the other patient at that time and asked RN C to take the other patient up to Obstetrics. Per Registrar D, "I took the second patient (Pt #1) into registration and asked her name. I could not find her pre-registration." Registrar D asked her name and date of birth, then called OB and spoke with (RN G). Per Registrar D, RN G said "we don't have any beds, could they go to (Hospital A)." Registrar D stated "I took that to mean I should ask the patient if they could go to (Hospital A). The patient asked how far that was and at that same time the phone rang and it was Obstetrics (OB) telling me to bring the patient to room 156. I told the patient I could bring her right up and the lady with the patient said 'hell no' and wheeled her out."

Per Registrar D, when an OB comes in they are usually pre-registered. Registrar D stated "I get their name and pull their packet and bring them up to OB. This patient was not pre-registered and her name was not in the system." Registrar D also stated, "I started to put her in the system then stopped when she left. I deleted the entry when she left." Registrar D stated she reported the incident to the supervisor.

On 5/17/16, review of the ED log showed no Obstetrics patients for the proceeding six months.

On 5/17/16 at 10:05 AM, reviewed facility the policy titled "Emergency Department Logs - Creation and Maintenance to Meet EMTALA Requirements" dated 2/15/2016 was reviewed. This policy states, "Every individual who presents to Patient Access and/or the ED and requests any interaction with staff, nurses, or physicians or any other medical/behavioral health services MUST be registered and a chart/record created."

During an interview with Supervisor of Health Information Management K on 5/17/16 at 12:00 PM it was confirmed that Pt #1 was did not have a medical record or medical record number at this facility and did not appear on the ED log for 5/11/16.

Based on record review, interview and observation, Emergency Department staff at this facility failed to complete a comprehensive medical screening examination on 1 of 20 (#1) patients who presented to the emergency department seeing medical treatment. This deficient practice has the potential to affect all patients seeking emergency medical treatment at this facility.

Findings include:

Observation of the video recording of patient #1 at Emergency Department (ED) registration area, accompanied by President A and Risk Management Specialist B on 5/17/16 at 9:50 AM. Video revealed: at 4:06 AM patient #1 arrives at registration via wheelchair, 4:07 AM approached by person identified as Registered Nurse (RN) C and ED technician D, 4:09 AM patient #1 goes into registrar area, 4:11 AM patient (Pt) #1 leaves through waiting room via wheelchair.

On 5/17/16 at 10:00 AM, conducted interview with Registrar D. Registrar D stated "I was with another Obstetrics (OB) patient when the (patient #1) arrived. I asked them if they needed the ER when I seen them come around the corner. They said yes and I called (Registered Nurse C) in the ED and (RN C) and (ED technician D) came out. The patient told (RN C) her water broke and (RN C) asked if she needed to push. "Registrar D had finished with the other patient at that time and asked RN C to take the other patient up to OB. Per Registrar D, "I took the second patient (Pt #1) into registration and asked her name. I could not find her pre-registration." Registrar D asked her name and date of birth, then called OB and spoke with (RN G). Per Registrar D, RN G said "we don't have any beds, could they go to (Hospital A)." Registrar D stated " I took that to mean I should ask the patient if they could go to (Hospital A). The patient asked how far that was and at that same time the phone rang and it was Obstetrics (OB) telling me to bring the patient to room 156. I told the patient I could bring her right up and the lady with the patient said 'hell no' and wheeled her out."

On 5/17/16 at 10:25 AM reviewed facility policy titled "EMTALA:Medical Screening, Stabilization/Treatment and Transfer for Emergency Medical Conditions" dated 7/3/2015. This policy states "Any patient who comes to the Dedicated Emergency Department and requests emergency examination and treatment will be provided an appropriate medical screening examination to determine whether an emergency medical condition exists."

On 5/17/16 at 10:45 AM, conducted interview with OB RN G. OB RN G stated (Registrar D) called to tell me there was another OB patient here, not the one we already knew was coming up. While (Registrar D) was on the line I said to another nurse "another one is come, we need a bed." Per OB RN G "were already re-arranging assignments and were not sure if we had another bed, not a room but a labor bed itself. I asked the other nurse if the patient could go to (Hospital A) and (Registrar D) through I was talking to her and hung up. I called back to (Registrar D) a few minutes later and told her the patient could go to room 156."

On 5/17/16 at 11:15 AM, conducted interview with ED RN C via telephone. RN C stated Registrar D called back to the ED and said there was already an OB patient in registration and another OB patient was waiting and needed to be seen. RN C went out to registration to see the patient and asked "how may we help." RN C stated a quick verbal assessment was done and asked how long ago Pt #1's water broke and if she needed to push etc. At that point, Registrar D asked me to take the other patient up to OB and took Pt #1 into registration. RN C and ED technician D took the other OB patient up to the OB floor. RN C let the OB staff know there was another patient in registration and RN C and ED technician E headed back down to the ED department. RN C expected to meet Registrar D halfway in the hall with Pt #1 but did not see them. RN C stated Registrar D came to the ED to explain to RN C that Pt #1 left and that there was a mix up in OB. RN C then reported to the night supervisor there was an incident.

The Supervisor of Health Information Management K on 5/17/16 at 12:00 PM confirmed during interview that Pt #1 did not have a medical record, medical record number or a documented medical screening exam.