Based on interview and record review the facility failed to ensure: A. emergency personnel designated as being on the trauma team were available to provide emergency services at all times. B. there was efficient coordination between trauma team members and the ED (emergency department) personnel. C. documentation of monitoring on a physician who's scheduling of elective surgeries caused conflicts with the trauma team availability. Refer to tag A1103 for additional information.

Based on interview and record review the facility failed to ensure: A. emergency personnel designated as being on the trauma team were available to provide emergency services at all times. B. there was efficient coordination between trauma team members and the ED (emergency department) personnel. C. documentation of monitoring on a physician who's scheduling of elective surgeries caused conflicts with the trauma team availability. This deficient practice was found in 1 of 1 ED and had the likelihood to cause harm to all patients presenting to the emergency department (ED). Findings include: Review of the clinical record on Patient #8 revealed he was a [AGE] year old male who (MDS) dated [DATE] (Sunday) with a gunshot wound (GSW) to the abdomen. According to the chart the switchboard was notified and a trauma alert page was made at 6:55 p.m. CPR (cardio-pulmonary resuscitation) was started on Patient #8 enroute to the facility and Patient #8 was in asystole (without cardiac activity) on arrival to the hospital at 6:57 p.m. CPR continued in the ED. Surgeon #20 performed a thoracotomy (surgical cut to open the chest wall up) to clamp the aorta (largest artery in the body) in the ED. After 45 minutes of CPR the code was called off. According to the record, Patient #8's time of death was 7:40 p.m. Review of form named "TRAUMA TEAM ALERT/ACTIVITION and RESPONSE TIMES" dated 04/05/2015 revealed sections for staff on the trauma team to sign in and time on arrival to the ED. Surgical nurses, anesthesia, and the surgical tech was signed and timed in at 7:00 p.m. Lab did not sign in and two of the physicians and the house supervisor signed the sheet, but failed to time in. Review of a facility investigation and resolution plan revealed two occurrence reports were received on 04/05/2015 involving Physician #22 behavior. Physician #22 was performing elective surgeries after hours and on weekends. On 04/05/2015 he scheduled an elective surgery, the surgery call crew showed up at the hospital at 3:00 p.m., and eventually left at 4:40 p.m. because the physician had not showed up at the hospital. Physician #22 showed up at 6:00 p.m. and the call crew had to come back in. According to the report on 04/09/2015, a meeting was held with the operating room (OR) nurses involving events that occurred on Sunday (04/05/2015). A review was performed on the case of the GSW in the ED (Patient #8) that was unable to go to the OR due to call crew in an elective case. On 04/17/2015 additional complaints came in about Physician #22 intentionally delaying cases in order to keep operating room crew there after hours. The facility met with Physician #22 on 04/22/2015 and he was placed on a corrective action plan. During interviews on 07/22/2015 after 9:15 a.m., the following was reported about emergency services involving the trauma team: Staff #1 reported because of the 04/05/2015 and other complaints Physician #22 was placed on terms. Staff #1 reported the surgeon would not have taken Patient #8 to the operating room because he was already coding. Because of the potential of needing to go to surgery, that prompted them to no longer do elective cases on the weekend. Staff #1 reported the back-up plan was to call additional staff in when the trauma team staff were in an (emergent) surgery on the weekend. Staff #1 reported spots checks were done on Physician #22 to make sure he was complying, but she had no documentation of that. Staff #16 confirmed the problems they had with Physician #22 and the incident that occurred on 04/05/2015. Staff #1 confirmed the plan was for no elective surgeries to be performed on the weekend. They would only do emergent cases on inpatients only. Staff #16 confirmed there was no backup plan for his operating room staff that was scheduled for an emergent surgical case and the trauma team at the same time. Staff #16 reported he guesses himself or another nurse would have to be the back-up. Staff #16 reported there was only 8 nurses working in surgery and if he had to put them on call like that they would lose nurses. Staff #16 reported he was monitoring Physician #22 surgery scheduling, but was not keeping documentation of compliance. Staff #17 confirmed she was scheduled to be on the trauma team on 04/05/2015, but was in an elective surgery. Staff #17 reported while they were in surgery, the house supervisor came back to the surgery area a couple of times asking for supplies for the ED. Staff #17 confirmed there was no back-up plan if they were tied up with urgent surgeries and were also scheduled for the trauma team. Staff #17 confirmed she signed the other surgery staff names on the trauma code form and put the times of 7:00 p.m. on the sheet. Staff #17 confirmed the surgical case did not end until 7:10 p.m. and the patient went to recovery at 7:12 p.m. Staff #17 confirmed they were not in the ED at the documented time. Staff #18 confirmed she was scheduled to be on the trauma team on 04/05/2015, but was in an elective surgery. Staff #18 confirmed her name was written on the code sheet, but she never went to the ED because she was recovering a patient. Staff #18 confirmed she did not know a trauma patient was in the ED because she did not hear a page for a Code 88. Staff #18 reported the backup plan for when she was scheduled for an emergent case and the trauma team at the same time was as follows; to finish her patient in recovery as soon as possible and then go the ED or call her charge nurse. Staff #19 (Chief nursing officer) and Staff #3 (Chief executive officer) reported the backup plan for the trauma team replacement would be to call staff who were not on the first trauma team in. They both reported there was no documentation on Physician #22 to show he was complying with the scheduling problem. Staff #2 (Quality) reported the backup plan would be to stabilize the patient and transfer them out. The facility failed to ensure staff had clear knowledge of the back up plan in the event the operating room staff was on a case and scheduled for the trauma team at the same time. There was no documented monitoring of the Physician #22 who scheduled a weekend elective case during the timeframe the operating room staff was scheduled for the trauma team on-call duty on 04/05/2015. Review of a policy named "Trauma Team Protocol" approved 01/2014 revealed the following: Purpose: To provide an efficient, coordinated approach to caring for the severely injured trauma patient. 1. ACTIVATION OF TRAUMA ALERT PROTOCOL: The Trauma Alert protocol should be activated (trauma team mobilized) upon notification from pre-hospital provides that a CRITICAL trauma patient is in route to the trauma center. 2. PRIOR TO ARRIVAL-(PREPARATION) Trauma team members should assume the following responsibilities: 4. TRAUMA TEAM MEMBERS RESPONSIBILITIES: a. Emergency Department Physician i. Assumes responsibility for injured patient until Surgeon arrives. Perform assessments, procedures and diagnostic studies as necessary. l.Operating Room Personnel The surgery department is jointly committed as various other departments within the facility to provide safe and appropriate care for those patients requiring prompt surgical intervention as a result of trauma. i.Surgical Notification: 1. The surgery department should be notified by appropriate Emergency Department personnel during normal hours of operation of a potential trauma case requiring surgical intervention by the paging system. 2. The Surgery Charge Nurse or designated person should advise the OR personnel and begin preparing for the potential case. 3. The surgeon should notify the surgery department to verify the need for special equipment and availability of room. 4. The RN circulator should notify the Surgery Charge Nurse of need for additional personnel during afterhours procedures. iv.Staff Availability 1. The surgery department should maintain appropriate staffing during normal operation to handle the requirements of trauma. 2. Surgery department staff are on-call after hours and for weekend/holiday coverage. The call crew should respond within 30 minutes of notification. 3. The need for additional personnel should be at the discretion of the RN circulator who is responsible for contacting the Surgery Charge Nurse as soon as possible.