Based on review of hospital documentation, review of policies and procedures and interviews with hospital personnel, the hospital failed to ensure that the emergency department log was complete. The findings include: Review of the Emergency Department (ED) Log dated 8/1/16-2/22/17 failed to identify consistent documentation when a patient who presented to the ED, whether they refused treatment, was refused treatment, whether they were transferred, admitted , treated, stabilized and discharged . Interview and review with the Director of Risk Management on 2/22/17 identified that the ED logs identified listed the patients seen in the ED, however, lacked the required information to include whether they refused treatment, was refused treatment, whether they were transferred, admitted , treated, stabilized and discharged .

Based on clinical record reviews, review of hospital policies and procedures and interviews with facility personnel for one of thirty sampled patients (Patient #21), the facility failed to ensure the patient received a medical screening prior to transfer to another hospital. The findings include: Patient #21 had a history of a cerebral vascular accident. Patient #21 was transported by ambulance to the Emergency Department (ED) on 2/14/17 at 2:17am. Review of the ambulance run sheet dated 2/14/17 identified that the patient was unresponsive, snoring respirations, skin was flushed and was diaphoretic. Further review of the ambulance run sheet identified the patient had a Glasgow coma score of 3 (normal score-15), blood pressure 173/95 (normal-140/80), oxygen saturation level of 94%, with a further assessment that identified the patient's eyes were opening to verbal stimuli and was following commands. The Emergency Medical Service (EMS) stroke assessment revealed that the left arm and left leg were paralyzed with no facial droop and no right sided deficits. Patient #21 was moved out of the ambulance and into the ED via stretcher. Assistant Director of Nurses (ADN) #1 indicated to EMS staff that he/she was not accepting the patient because they did not have any available beds in the ED. ADN #1 instructed the EMS staff to transport the patient to another hospital (Hospital #2). Patient #21 failed to have a medical screening exam by a qualified medical personnel. Patient #21 was transported to Hospital #2 and arrived at 3:21am. Review of Hospital #2's clinical record identified that the patient was diagnosed with seizures and discharged on [DATE]. Interview with the Assistant Director of Nurses (ADN) #1 on 2/23/17 indicated that he/she knew the patient would of had to wait to be treated in the ED because of no available beds so he/she directed EMS to send the patient to another hospital for treatment therefore the patient did not receive a medical examination and/or treatment. Interview with the Director of Risk Management on 2/22/17 identified that Patient #21 was brought to the ED by EMS. The ED had no beds available and was not on diversion. Further interview identified that the ADN directed EMS to send the patient to Hospital #2 without having a medical screening exam by a provider. Review of hospital policy identified that when an individual comes to the hospital ED requesting a medical examination or treatment, a Qualified Medical Person shall provide a medical screening exam to determine whether an Emergency Medical Condition exists.