Based upon medical record review, document review and interview, the facility did not comply with all the provisions for maintaining a central log and conducting a medical screening exam. Please reference findings under Tag A 2405 and 2406.

Based on policy review, medical record review, document review and interview, the facility did not ensure all individuals presenting to the Emergency Department (ED) are entered into the central log for 1 of 21 patients (Patient #1). Not entering a patient in the central log could result in a patient not receiving a medical screening exam. Findings include: Review on 09/25/18 of policy "Medical Screening Examinations, Stabilizing Treatment and Appropriate Transfers" dated 12/04/17 indicates patients who present to the ED will be registered in the patient information system and in the central log after triage. The date and time of arrival, name, address, date of birth and nature of their complaint should be recorded. If a patient leaves before triage or registration, available information will still be entered into the central log. Telephone interview on 09/26/18 at 01:35 PM with Staff (V), Registration Clerk, revealed a " mother " and young boy came into the ED asking for a pediatric social worker. Staff (V) contacted Staff (H), Social Worker, who came down to speak with them. Telephone interview on 09/26/18 at 11:10 AM with Staff (H), Social Worker revealed a " mother " and male child came to the ED, presented to the registration desk and inquired about seeing a pediatric social worker. The mother indicated that " the school " wanted a psychiatric evaluation for her child. Staff (H) told the mother that an evaluation could be done there. The mother indicated that the last time she brought her daughter here, they were here all weekend and asked about other local facilities where she could take her child to. Staff (H) gave her the names of psychiatric units, indicating the type of programs they have. Prior to leaving, Staff (H) stated that the child could be seen here, but if he needed admission, the child would need to be transferred. No patient information was given to Staff (H) by the mother and the patient was not registered. Review on 09/25/18 of the ED Central Log for September 2018 revealed Patient #1 was not entered into the log. Medical record review on 09/25/18 at 04:15 PM with Staff (E), Assistant ED Manager revealed no evidence that a medical record was generated for Patient #1.

Based on policy review, medical record review, document review and interview the hospital did not provide a medical screening exam (MSE) for 1 of 21 patients who presented to the Emergency Department (Patient #1). A lack of a MSE could result in an emergency medical condition not being identified and treated. Findings include: Review on 09/25/18 of policy "Medical Screening Examinations, Stabilizing Treatment and Appropriate Transfers" dated 12/04/17 indicates patients who present to the ED will be registered in the patient information system and in the central log after triage. The date and time of arrival, name, address, date of birth and nature of their complaint should be recorded. If a patient leaves before triage or registration, available information will still be entered into the central log. Review on 09/25/18 of the " Medical Staff Rules & Regulations " dated 12/14/17 indicates patients coming to the ED requesting evaluation and treatment will have a medical screening examination as required by Federal law by a qualified medical professional (Physicians, Physician Assistants, Nurse Practitioners and trained obstetrical nurses in consultation with an OB provider). Telephone interview on 09/26/18 at 01:35 PM with Staff (V), Registration Clerk, revealed a " mother " and young boy came in asking for a pediatric social worker. Staff (V) believes the mother and child were referred from school, looking for an evaluation and weren ' t sure where to go. The mother had a paper in her hand. Staff (V) called Staff (H), Social Worker, who came down to talk with them. Telephone interview on 09/26/18 at 11:10 AM with Staff (H), Social Worker revealed a " mother " and male child came to the ED, presented to the registration desk and inquired about seeing a pediatric social worker. The mother indicated that " the school " wanted a psychiatric evaluation for her child. Staff (H) told the mother that an evaluation could be done there. The mother indicated that the last time she brought her daughter here, they were here all weekend and asked about other local facilities where she could take her child to. Staff (H) gave her the names of psychiatric units, indicating the type of programs they have. Prior to leaving, Staff (H) stated that the child could be seen here, but if he needed admission, the child would need to be transferred. No patient information was given to Staff (H) by the mother and medical screening exam was not conducted. Medical record review on 09/25/18 at 04:15 PM with Staff (E), Assistant ED Manager revealed no evidence that a medical record was generated for Patient #1. Review on 09/27/18 of the ED medical record from another hospital revealed on 09/14/18 at 04:01 PM Patient #1 arrived at their facility. The patient presented with a referral from the school social worker for a psychiatric evaluation after a friend reported that the patient intended to kill himself. The patient was triaged and had a MSE with psychiatric consultation. Patient #1 remained in the ED until 09/17/18 when he was transferred to an inpatient Adolescent Psychiatric Center.

Based upon document review and interview, the facility did not comply with all of the provisions for maintaining a central log and conducting a medical screening exam. Please reference findings under Tag A2405 and A2406.

Based on document review and interview, the facility failed to ensure all individuals presenting to the Emergency Department (ED) are entered into the central log for 1 of 22 patients (Patient #1). This failure could result in the patient not receiving a medical screening exam. Findings include: Review of the facility's Lockout Team Debrief dated 11/7/17 revealed the hospital was placed on lock-down from 11/2/17 at 10:35pm to 11/3/17 at 3:35am following a security alert. During the lock-down a laboring patient presented by personal vehicle to the hospital parking lot and was stopped by Security personnel. The patient was informed that the facility was locked down and was re-directed to the next nearest hospital. Interview with Staff (P), Security on 11/14/17 at 12:15pm revealed Patient #1 presented to the hospital entrance indicating she was in labor on 11/3/17 during the time when the facility was in lock-down. Staff (P) directed the patient to go to the next nearest hospital. Staff (P) stated he was not aware that all patients presenting for emergency care must be entered into the central log and have a medical screening exam. Review of the facility policy and procedure # CVH950-232 EMT effective 7/25/17 revealed all patients presenting for emergency care and treatment will be logged into the central log and a medical screening exam will be conducted by a qualified medical professional. Review of the facility Emergency Department log dated 11/3/17 revealed Patient #1 was not entered into the log. Interview with Staff (A), President and (C), Regulatory Compliance on 11/13/17 confirmed that Patient #1 presented to the hospital for emergency care and was not entered into the central log.

Based on document review and interview, the hospital did not provide a medical screening exam (MSE) for 1 of 22 patients who presented to the hospital for emergency care (Patient #1). A lack of a medical screening exam could result in an emergency medical condition not being identified and treated. Findings include: Review of the facility's Lockout Team Debrief dated 11/7/17 revealed the hospital was placed on lock-down from 11/2/17 at 10:35pm to 11/3/17 at 3:35am following a security alert. During the lock-down a laboring patient presented by personal vehicle to the hospital parking lot and was stopped by Security personnel. The patient was informed that the facility was locked down and was re-directed to the next nearest hospital without receiving a medical screening examination. Review of the facility Medical Staff Bylaws/ Rules and Regulations revealed all patients presenting to the Emergency Department, Labor/Delivery/Post -Partum Department or other areas as described in the Emergency Treatment and Active Labor Act Policy and requesting evaluation and treatment will have a medical screening exam provided by a qualified medical professional. Interview with Staff (A), President on 11/14/17 revealed Patient #1 presented to the Emergency Department (ED) on 11/3/17 at approximately 2:00am in active labor. At the time of the patient's arrival to the ED, the hospital was in lock-down status due to a security alert in the area. Staff (P), Security informed the patient that the hospital was not allowing patients to enter or exit the building. Staff (P) directed the patient to go to the next nearest hospital. The patient did not receive a medical screening exam.