Based on review of documents provided by the facility, it was determined the facility failed to ensure all patients presenting to the Emergency Department were entered into the central log. Findings include: MR1, an [AGE]-year-old patient, was brought to the Emergency Department (ED) by their caregiver on February 10, 2016, at 1930. Registration Clerk was taking a patient to their room. The ED was very busy. The ED nurse was in Registration office after finishing a triage on another patient and saw the patient and caregiver. The ED nurse knew the caregiver and opened the triage door and greeted the caregiver in the hallway. The caregiver asked how long the nurse thought the wait would be and nurse replied that it would definitely be a while due to the number of patients waiting to be seen. The caregiver replied that maybe they should take MR1 home and return at a later time. The nurse offered services. The caregiver thanked the nurse and said stated they would bring the patient back. MR1 was not quick registered, entered into the ED log book, triaged, provided a medical screening, or offered a withdrawal of care. MR1 returned on February 11, 2016, at 0944, was evaluated in ED, and admitted to acute inpatient for a urinary tract infection, early sepsis, and confusion. The facility immediately institute the following plan of corrective action: 1. Upon discovery of the incident, the infrastructure failure of the EMTALA violation was properly reported by Corry Memorial Hospital through the PA PSRS system on February 12, 2016, Attachment 1. After a thorough investigation and interviews with all staff present on that date and time of the event, it was determined that the RN worked alone and no one else had knowledge of the patient and caregiver presenting for care and subsequently leaving on Wednesday, February 10, 2016. 2. This corrective action plan was developed on February 15, 2016. 3. A memo was distributed February 15, 2016 to all Emergency Department physicians, nurses, and registration staff, Attachment 2, outlining the following: a. All patients must be quick registered in the Emergency Department and must be recorded in the Emergency Department log book without exception. After quick registration, they must be taken to triage. b. The nurse and/or physician should not be consulted prior to the patient being quick registered. It is inappropriate to give advice or comment on what may or may not be done once evaluated by the physician prior to the patient being quick registered and triaged. c. No charge is assessed the patient for quick registration and triage. d. If patients refuse to give their name or refuse to be registered, you can still quick register them under a temporary name, so that there is paperwork to document their presence and they can proceed to triage. e. It may also be appropriate that if the patient wants to leave, any staff member including the Registration Staff can request that they sign the Withdrawal of Treatment form prior to them leaving. f. All of these situations must be written up on an incident report. 4. A mandatory meeting for all Emergency Department physicians, nurses, and registration staff will be held Monday, February 22, 2016 at 0800 to review the incident and re-education of the proper procedures to remain in compliance with EMTALA. All staff from the ED physicians, ED Nursing, and ED Registration will attend. Attachment 3 and 4. 5. Education for 2015 had been completed. This includes, New Hire Orientation which was completed May 14, 2015, August 20, 2015, and November 12, 2015; Annual In-service education was completed June 25, 2015 and August 18, 2015; EMTALA education was done August 2015 for ED staff; and Competencies for ED Nurse and Registration staff were completed on an individual basis throughout 2015. Mandatory re-education competencies for all ED physicians, nurses, and registration staff will be done and completed by February 29, 2016. 6. The RN Nursing Staff employee received a Written Warning per our HR Disciplinary process on February 15, 2016. She was counseled as to how she should have handled the situation differently. This RN had completed all required EMTALA training as a new employee. She received Pre-employment training on October 14, 2015, she completed New Hire orientation which includes EMTALA training on November 12, 2016, and she completed her EMTALA competency on December 8, 2015. She will complete remedial training on EMTALA by February 19, 2016. 7. The Emergency Department Log will be monitored through the QI process on a monthly basis for a minimum of six months beginning February 12, 2016 and then quarterly thereafter unless there continues to be discrepancies between the Registration Quick Admits, ED Patient Registrations, the ED Log, and Incident Reports. Results of this audit will be reported to the QI Committee by the Patient Account/Registration Manager. 8. A QI indicator previously developed for EMTALA training for new medical staff and allied health staff, new hires and annual education to monitor compliance with training will be continued. This will be reported monthly to the QI Committee for six months beginning March 2016 and then quarterly thereafter by the Employee Health Department. All EMTALA policies will be reviewed and updated as necessary over the next several weeks and will be sent to Medical Executive Committee on March 22, 2016 with any revisions.

Based on review of documents provided by the facility, it was determined the facility failed to ensure all patients presenting to the Emergency Department were provided with a medical screening examination. Findings include: MR1, an [AGE]-year-old patient, was brought to the Emergency Department (ED) by their caregiver on February 10, 2016, at 1930. Registration Clerk was taking a patient to their room. The ED was very busy. The ED nurse was in Registration office after finishing a triage on another patient and saw the patient and caregiver. The ED nurse knew the caregiver and opened the triage door and greeted the caregiver in the hallway. The caregiver asked how long the nurse thought the wait would be and nurse replied that it would definitely be a while due to the number of patients waiting to be seen. The caregiver replied that maybe they should take MR1 home and return at a later time. The nurse offered services. The caregiver thanked the nurse and said stated they would bring the patient back. MR1 was not quick registered, entered into the ED log book, triaged, provided a medical screening, or offered a withdrawal of care. MR1 returned on February 11, 2016, at 0944, was evaluated in ED, and admitted to acute inpatient for a urinary tract infection, early sepsis, and confusion. The facility immediately institute the following plan of corrective action: 1. Upon discovery of the incident, an infrastructure failure of the EMTALA violation was properly reported by Corry Memorial Hospital through the PA PSRS system on February 12, 2016, Attachment 1. After a thorough investigation and interviews with all staff present on that date and time of the event, it was determined that the RN worked alone and no one else had knowledge of the patient and caregiver presenting for care and subsequently leaving on Wednesday, February 10, 2016. 2. This corrective action plan was developed on February 15, 2016. 3. A memo was distributed February 15, 2016 to all Emergency Department physicians, nurses, and registration staff, Attachment 2, outlining the following: a. All patients must be quick registered in the Emergency Department and must be recorded in the Emergency Department log book without exception. After quick registration, they must be taken to triage. b. The nurse and/or physician should not be consulted prior to the patient being quick registered. It is inappropriate to give advice or comment on what may or may not be done once evaluated by the physician prior to the patient being quick registered and triaged. c. No charge is assessed the patient for quick registration and triage. d. If patients refuse to give their name or refuse to be registered, you can still quick register them under a temporary name, so that there is paperwork to document their presence and they can proceed to triage. e. It may also be appropriate that if the patient wants to leave, any staff member including the Registration Staff can request that they sign the Withdrawal of Treatment form prior to them leaving. f. All of these situations must be written up on an incident report. 4. A mandatory meeting for all Emergency Department physicians, nurses, and registration staff will be held Monday, February 22, 2016 at 0800 to review the incident and re-education of the proper procedures to remain in compliance with EMTALA. All staff from the ED physicians, ED Nursing, and ED Registration will attend. Attachment 3 and 4. 5. Education for 2015 had been completed. This includes, New Hire Orientation which was completed May 14, 2015, August 20, 2015, and November 12, 2015; Annual In-service education was completed June 25, 2015 and August 18, 2015; EMTALA education was done August 2015 for ED staff; and Competencies for ED Nurse and Registration staff were completed on an individual basis throughout 2015. Mandatory re-education competencies for all ED physicians, nurses, and registration staff will be done and completed by February 29, 2016. 6. The Nursing Staff employee received a Written Warning per our HR Disciplinary process on February 15, 2016. She was counseled as to how she should have handled the situation differently. She will do remedial EMTALA training by Friday February 19, 2016. This RN had completed all required EMTALA training as a new employee. She received Pre-employment training on October 14, 2015, she completed New Hire orientation which includes EMTALA training on November 12, 2015, and she completed her EMTALA competency on December 8, 2015. She will complete remedial training on EMTALA by February 19, 2016. 7. The Emergency Department Log will be monitored through the QI process on a monthly basis for a minimum of six months beginning 5-11 and then quarterly thereafter unless there continues to be discrepancies between the Registration Quick Admits, ED Patient Registrations, and the ED Log. Results of this audit will be reported to the QI Committee by the Patient Account/Registration Manager. 8. A QI indicator previously developed for EMTALA training for new medical staff and allied health staff, new hires and annual education to monitor compliance with training will be continued. This will be reported monthly to the QI Committee for six months beginning 5-11 and then quarterly thereafter by the Employee Health Department. 9. All EMTALA policies will be reviewed and updated as necessary over the next several weeks and will be sent to Medical Executive Committee on March 22, 2016 with any revisions.