ER Inspector SOUTHERN TENNESSEE REGIONAL HLTH SYSTEM WINCHESTERSOUTHERN TENNESSEE REGIONAL HLTH SYSTEM WINCHESTER

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Updated September 19, 2019

This database was last updated in September 2019. It should only be used as a historical snapshot.Researchers can find more recent data on timely and effective care in the Centers for Medicare and Medicaid Services’ hospitals datasets and guidance about hospital regulations.

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ER Inspector » Tennessee » SOUTHERN TENNESSEE REGIONAL HLTH SYSTEM WINCHESTER

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SOUTHERN TENNESSEE REGIONAL HLTH SYSTEM WINCHESTER

185 hospital road, winchester, Tenn. 37398

(931) 967-8295

69% of Patients Would "Definitely Recommend" this Hospital
(Tenn. Avg: 72%)

2 violations related to ER care since 2015

Hospital Type

Acute Care Hospitals

Hospital Owner

Proprietary

ER Volume

Low (0 - 20K patients a year)

See this hospital's CMS profile page or inspection reports.

Patient Pathways Through This ER

After a patient arrives at the emergency room, they are typically seen by a doctor or medical practitioner and then either sent home or admitted to the hospital and taken to a room. A small percentage of patients leave without being seen. The chart below shows on average how long each of these pathways take. Lower numbers are better, and all times refer to the average length of time people waited.

Arrives at ER
1% of patients leave without being seen
3hrs 22min Admitted to hospital
4hrs 28min Taken to room
2hrs 6min Sent home

All wait times are average.

Detailed Quality Measures

Here is a more in depth look at each quality measure, compared to state and national averages for hospitals with low ER volumes. Experts caution that very small differences between hospitals for a given measure are unlikely to correspond to noticeable differences in the real world.

Measure
Average for this Hospital
How this Hospital Compares

(to other hospitals with similar
ER volumes, when available)

Discharged Patients
Time Until Sent Home

Average time patients spent in the emergency room before being sent home (if not admitted).

2hrs 6min
National Avg.
1hr 53min
Tenn. Avg.
1hr 54min
This Hospital
2hrs 6min
Impatient Patients
Left Without
Being Seen

Percentage of patients who left the emergency room without being seen by a doctor or medical practitioner.

1%
Avg. U.S. Hospital
2%
Avg. Tenn. Hospital
2%
This Hospital
1%
Admitted Patients
Time Before Admission

Average time patients spent in the emergency room before being admitted to the hospital.

3hrs 22min

Data submitted were based on a sample of cases/patients.

National Avg.
3hrs 30min
Tenn. Avg.
3hrs 30min
This Hospital
3hrs 22min
Admitted Patients
Transfer Time

Among patients admitted, additional time they spent waiting before being taken to their room (sometimes referred to as "boarding time.")

1hr 6min

Data submitted were based on a sample of cases/patients.

National Avg.
57min
Tenn. Avg.
55min
This Hospital
1hr 6min
Special Patients
CT Scan

Percentage of patients who arrived with stroke symptoms and did not receive brain scan results within 45 mins.

11%
National Avg.
27%
Tenn. Avg.
29%
This Hospital
11%

Violations Related to ER Care

Problems found in emergency rooms at this hospital since 2015, as identified during the investigation of a complaint. About This Data →

Violation
Full Text
COMPLIANCE WITH 489.24

Oct 3, 2017

Based on review of Tennessee Code Annotated 63-7-103 (Tennessee Practice of Professional Nursing), review of medical staff bylaws, review of facility policies, medical record review, and interviews, the facility failed to provide a Medical Screening Examination by a Qualified Medical Provider for 2 patients (#27 and #28) of 30 Emergency Department (ED) patients reviewed.

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Based on review of Tennessee Code Annotated 63-7-103 (Tennessee Practice of Professional Nursing), review of medical staff bylaws, review of facility policies, medical record review, and interviews, the facility failed to provide a Medical Screening Examination by a Qualified Medical Provider for 2 patients (#27 and #28) of 30 Emergency Department (ED) patients reviewed. Refer to 2406 for failure to provide a medical screening examination.

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MEDICAL SCREENING EXAM

Oct 3, 2017

Based on review of Tennessee Code Annotated 63-7-103 (Tennessee Practice of Professional Nursing), review of medical staff bylaws, review of facility policies, medical record review, and interviews, the facility failed to provide a Medical Screening Examination (MSE) by a Qualified Medical Provider (QMP) for 3 patients (#27 and #28) of 30 Emergency Department (ED) patients reviewed.

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Based on review of Tennessee Code Annotated 63-7-103 (Tennessee Practice of Professional Nursing), review of medical staff bylaws, review of facility policies, medical record review, and interviews, the facility failed to provide a Medical Screening Examination (MSE) by a Qualified Medical Provider (QMP) for 3 patients (#27 and #28) of 30 Emergency Department (ED) patients reviewed. The findings included: Review of the Tennessee Code Annotated 63-7-103 "...Title 63 Professions of the Healing Arts...Nursing...General Provisions..." dated 2016, revealed "...professional nursing includes...(A) Responsible supervision of a patient...(B) Promotion, restoration and maintenance of health or prevention of illness of others...(C) Counseling, managing, supervising and teaching of others...(D) Administration of medications and treatments as prescribed by a licensed physician...or nurse authorized to prescribe...(E) Application of such nursing procedures as involve understanding of cause and effect...(F) Nursing management of illness, injury or infirmity...(b) the practice of professional nursing does not include acts of medical diagnosis or the development of a medical plan or care..." Continued review did not specify Registered Nurses (RN) were permitted to complete Medical Screening Examinations under the Tennessee Nurse Practice Act. Review of "Medical Staff Bylaws of Southern Tennessee Regional Health System - Winchester and Sewanee" adopted March 30, 2000, revealed, "...Any individual, who presents to the hospital property or premises, with a request for care, will be provided a medical screening examination to determine if a medical emergency condition exists. The exam may be performed by the Emergency Department physician in the Emergency Department or in the case of an obstetrical patient, by a Qualified Medical Person (designated Obstetrical Registered Nurse) in the Childbirth Center..." Review of the facility's policy, "LL.026, EMTALA - Medical Screening and Treatment of Emergency Medical Conditions" approved 12/4/13 revealed "...any individual who comes to the Hospital Property or Premises requesting an examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by a physician or other Qualified Medical Person...Qualified Medical Person or Personnel, or QMP, means an individual other than a licensed physician who has demonstrated current competence in the performance of Medical Screening Examinations and been approved by the main Hospital provider's governing board as qualified to administer one or more types of Medical Screening Examinations...The categories of non-physician practitioners who may be designated as QMPs is set forth in the Medical Staff Bylaws..." Review of the facility's policy titled "Assessment of Obstetrical Patients in the Emergency Department, 1-600-9.16" last reviewed 8/2015 revealed, "...Obstetrical patients at more than 20 weeks gestation, with a chief complaint related to the pregnancy are transported to the Childbirth Center. The qualified medical person in the Childbirth Center performs a Medical Screening Examination..." Medical record review revealed Patient #27 arrived at the ED on 9/27/17 at 2:45 PM with complaint of nausea, high heart rate, and lower back pain. Medical record review of a nurse's flow sheet dated 9/27/17 at 2:58 PM revealed "...G1P0 [first pregnancy] 21 Y.O. [[AGE] years old] PATIENT OF DR [named obstetrician] IS AMBULATORY TO OB [obstetrics] FLOOR FOR COMPLAINTS OF FEELING LIKE PASSING OUT AT WORK. PT [patient] STATES SHE GOT HOT NAUSEATED, AND HAS BACK PAIN. PT DENIES LOF [leaking of amniotic fluid], VAGINAL BLEEDING AND STATES POSITIVE FM [fetal movement] EDD [estimated delivery date] 10/25/17. PT IS 36 WEEKS TODAY..." Continued review at 3:12 PM revealed the patient was placed on a fetal monitor and had a vaginal exam by the RN at 3:28 PM. Further review at 3:30 PM revealed "...DR [named obstetrician] IS NOTIFIED OF PT'S ARRIVAL TO FLOOR WITH COMPLAINTS OF FEELING LIKE SHE WAS GOING TO PASS OUT AT WORK, NAUSEATED, AND BACK PAIN. MD [medical doctor] IS UPDATED ON VITAL SIGNS, FHR [fetal heart rate] PATTERN, AND SVE [sterile vaginal exam]. MD ORDERS R/O [rule out] LABOR PUSH FLUIDS AND TYLENOL..." Continued review at 5:22 PM revealed "...DR ...IS CALLED AND NOTIFIED OF FHR PATTERNS, CTX [contractions] PATTERN, AND TYLENOL ADMINISTRATION. MD ORDERS UA [urinalysis] AND CBC [complete blood count]..." Further review at 6:30 PM revealed "...DR...IS UPDATED ON FHR PATTERN, CTX PATTERN, LABS AND SVE UNCHANGED. MD ORDERS TO DISCHARGE PT HOME TO F/U [follow up] WITH HIM AT NEXT APPT [appointment]..." Continued review at 7:56 PM revealed "...Patient discharged to 'HOME'..." Further review revealed no documentation the patient was examined by a physician or any practitioner other than the Registered Nurse. Medical record review revealed Patient #28 (MDS) dated [DATE] at 9:50 AM for a complaint of dizziness at home. Medical record review of a Nurses Flow Sheet dated 9/29/17 at 9:50 AM revealed the patient was triaged with "...G1P0 [first pregnancy] 38 Y/O PT [[AGE] year old patient]...AMBULATED TO LD [labor and delivery] C/O [complaining of] LIGHT HEADEDNESS AND DIZZINESS THAT STARTED THIS MORNING...DENIES ANY LOF OR VAGINAL BLEEDING...CONFIRMS FETAL MOVEMENT..." Further review at 10:00 AM revealed "...DR. [named obstetrician] NOTIFIED OF PT ARRIVAL. ORDERS RECEIVED..." Further review revealed the patient was placed on a fetal monitor at 10:00 AM. Continued review at 11:38 AM revealed "...UDPDATED DR...ON PT STATUS. ORDER RECEIVED TO D/C [discharge] HOME..." Further review at 3:01 PM revealed "...Patient discharge to 'HOME'..." Further review revealed no documentation the patient was examined by a physician or any practitioner other than the Registered Nurse. Interview with the Interim OB Director on 10/3/17 at 3:00 PM, in the administrative conference room, revealed facility practice was for an OB RN, who had completed facility competencies in OB, to be designated as a QMP. Further interview confirmed Patients #27 and #28 were not provided a MSE by a physician or any other non-physician practitioner other than the RN.

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Notes

“Average time” refers to the median wait time (the midpoint of all patients' wait times). References to “doctor or medical practitioner” indicate a doctor, nurse practitioner or physician's assistant. CMS reports the CT scan quality measure as the percentage of patients who received a scan within 45 minutes. We have reversed that measure so that all measures follow a “lower is better” pattern.

Additional design and development by Mike Tigas and Sisi Wei.

Sources

All data comes from the Centers for Medicare and Medicaid Services. Detailed quality measures at the hospital, state and national level were last updated September 2019. Most data was collected between October 2017 and October 2018. Data on ER-related violations is from January 2015 to June 2019.

Additional Info

How We've Updated ER Inspector | Download ProPublica's Emergency Room Planning Toolkit | About This Data

Don’t See Your ER?

In some cases we aren’t able to identify the exact location of a hospital, so it doesn’t appear on our mapped search results. However, it may still be in our database – try looking for it in the list of hospitals on each state's page.

In other cases, the hospital is missing from our database because it doesn't have an emergency department.

In other cases, the hospital is missing from the federal government’s Centers for Medicare and Medicaid Services (CMS) data. There are a couple of reasons why a hospital isn’t included in CMS data: it may not participate in Medicare, or it may share a certification number with another hospital (common across large hospital systems).

If you notice a hospital missing from our database, please first check if you can find it on CMS' website, and that it is listed as having an ER. If so, please email us with the hospital name and address.