Based on review of medical records and documents, it was determined the facility failed to ensure that the standard of care was met for patient with a traumatic amputation injury. Specifically: (1) Staff failed to provide and document an accurate triage and evaluation of a traumatic injury, (2) Staff failed to communicate the need for timely intervention of a traumatic injury to other members of the health care team, (3) Staff failed to provide timely intervention and treatment to prevent potential harm to the patient with a traumatic injury. This finding was evident in Patient #4. Findings: Review of closed medical record conducted on 1/9/15 and 1/12/15 found that on November 28, 2014 at 13:07 (1:07 PM), this 3 year 7 month (3y7m) old female, patient #4, arrived at the facility with her family, with a Chief Complaint of Finger Injury, and received a Triage/Evaluation by the RN at 13:07 (1:07 PM). The evaluation documented in the ED Nursing Primary Evaluation Note states: Chief Complaint: Finger Injury; Pediatric Behavior Assessment: Patient does not display inappropriate sleepiness, irritability, lethargy/confusion, or a reduced response to pain; Vital Signs: Temperature 98.5 degrees Fahrenheit (F), Blood Pressure 111/72, Heart Rate 123, Respiration 20, Weight 15 kilograms (kg); Pain Assessment: No pain present. The Patient was assigned a Triage Acuity Level: 3 - Acute, and the record indicates the patient was triaged to the Pediatric Treatment Area. The documentation of the Finger Injury is unspecified. At 14:39 (2:39 PM), there is documentation in the ED Nursing Disposition Note that the patient "walked out prior to the LIP Exam"; patient left without being seen. Note 2: LIP Exam is an examination conducted by a Licensed Independent Practitioner. There is no other documented assessment in the medical record, and there is no documentation in the medical record to substantiate the allegation that the patient's fingertip and nail were amputated as a result of the injury. During a telephone interview on 01/21/15, at approximately 1:30 PM, patient's father stated that when he arrived at the Emergency Department (ED), the patient's finger was wrapped in tissue, and there was bleeding, and the fingertip was in his pocket, wrapped in tissue. The nurse removed the tissue and put a dressing on the finger and he was sent to Pediatrics. While the patient was in the Pediatric area, there were doctors present and he tried to get them to look at the finger that was in his pocket but they kept asking him to wait. He left the facility and took the patient to another facility (facility #2), which the patient's father identified by name. Review of the facility's policy titled: Triage of the Emergency Patient, received by the surveyor on 1/09/15, reveals there are no established guidelines and process for the triage nurse assessment and assignment of an acuity category, and there is no description of the acuity categories and actions to be taken. A request for the facility's policy for treatment of traumatic injury was made on 01/21/15 to Staff #3, but this policy was not received by the surveyor. Review of the medical record from facility #2, was conducted on 1/22/15 and revealed: On November 28, 2014, at approximately 14:58 (2:58 PM), the patient arrived at facility #2 with a Chief Complaint of Right Pinky Injury, was triaged to a Level 3 at 15:01 (3:01 PM) and was taken for Pediatric Assessment. The ED Pediatric Pre-Assessment by the RN, states: "Right 5th Finger Injury; as per patient's father, patient's brother slammed wood door on patient's Right 5th finger, cutting tip off around 12:45 PM today: bleeding controlled." Comprehensive Pain Assessment: Occasional grimace or frown, lying quietly, moans or whimpers, reassured by occasional touching, hugging/distractible; Pain Score: 3. Vital Signs: Temperature 37.6 degrees Celsius (C), Heart Rate 101, Respiratory Rate 18, Blood Pressure 136/73, Weight 15.6 kilograms (kg). At approximately 15:28 (3:28 PM), the Medical Screening Exam was initiated and the patient received evaluation and treatment to include: X-ray Finger 5th Digit and Ortho ED Consult. ED diagnosis indicated: Fingertip Amputation; Presented 5 hours (hrs) sp (status post) tip/nail avulsion. "Father states brought initially to NYH Queens, waited for some time, but wasn't seen so left and came here." Father has tip. Distal tip 5 hrs dry on gauze attached to nail. Medical care included: Tip immediately cleaned of gross debris and after irrigation was placed in Normal Saline (NS). Fingertip re-attachment done by hand team - may not attach permanently - father informed. Discharge: From (facility #2) ED at 19:44 (7:44 PM) on November 28, 2014.