ER Inspector TRIOSTRIOS

ER Inspector

Find and Evaluate Every Emergency Room Near You

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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TRIOS

900 south auburn street, kennewick, Wash. 99336

(509) 586-6111

68% of Patients Would "Definitely Recommend" this Hospital
(Wash. Avg: 72%)

4 violations related to ER care since 2015

Hospital Type

Acute Care Hospitals

Hospital Owner

Government - Hospital District or Authority

ER Volume

Medium (20K - 40K 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
2% of patients leave without being seen
4hrs 7min Admitted to hospital
5hrs 53min Taken to room
2hrs 7min 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 medium 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 7min
National Avg.
2hrs 23min
Wash. Avg.
2hrs 48min
This Hospital
2hrs 7min
Impatient Patients
Left Without
Being Seen

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

2%
Avg. U.S. Hospital
2%
Avg. Wash. Hospital
3%
This Hospital
2%
Admitted Patients
Time Before Admission

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

4hrs 7min

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

National Avg.
4hrs 21min
Wash. Avg.
5hrs 4min
This Hospital
4hrs 7min
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 46min

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

National Avg.
1hr 33min
Wash. Avg.
2hrs 14min
This Hospital
1hr 46min
Special Patients
CT Scan

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

0%
National Avg.
27%
Wash. Avg.
34%
This Hospital
0%

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

Dec 14, 2018

Based on observation, review of patient records, hospital policies and procedures and staff interviews, the hospital failed to comply with all requirements of 489.24. Refer to citations and examples at: A 2402 (489.20(q)) Required Signage - Hospital failed to ensure that public signage clearly specified that there was no Emergency Department at the Women and Children's Hospital campus and was posted in areas likely to be noticed by individuals entering the building. A 2405 (489.20 (r) (3)) emergency room Log - The hospital failed to ensure that all individuals who arrived at the Women and Children's Hospital requesting care were registered in a Log with pertinent information and documentation of their condition and disposition as determined by a qualified staff member. A 2406 (489.24(a)) Medical Screening Exam - The Hospital failed to appropriately assess and stabilize a mental health patient prior to sending them to the Mental Health Crisis Office (Patient #26); and failed to provide a procedure at the Women and Children's Hospital by which a staff member qualified by education and experience was available to screen individuals entering the building seeking medical assistance.

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Based on observation, review of patient records, hospital policies and procedures and staff interviews, the hospital failed to comply with all requirements of 489.24. Refer to citations and examples at: A 2402 (489.20(q)) Required Signage - Hospital failed to ensure that public signage clearly specified that there was no Emergency Department at the Women and Children's Hospital campus and was posted in areas likely to be noticed by individuals entering the building. A 2405 (489.20 (r) (3)) emergency room Log - The hospital failed to ensure that all individuals who arrived at the Women and Children's Hospital requesting care were registered in a Log with pertinent information and documentation of their condition and disposition as determined by a qualified staff member. A 2406 (489.24(a)) Medical Screening Exam - The Hospital failed to appropriately assess and stabilize a mental health patient prior to sending them to the Mental Health Crisis Office (Patient #26); and failed to provide a procedure at the Women and Children's Hospital by which a staff member qualified by education and experience was available to screen individuals entering the building seeking medical assistance. A procedural change put into place on 10/26/18 called for Security staff to ask questions and determine whether or not the individual was just needing to be redirected to the main hospital Emergency Department, or to call 911 to provide transport to the main hospital Emergency Department; and A 2406 (489.24(a)) Medical Screening Exam By Qualified Medical Personnel - The Hospital failed to have language in by-laws, approved by the Governing Body that specified which medically qualified personnel had been determined qualified to conduct emergency medical screening exams (MSEs).

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POSTING OF SIGNS

Dec 14, 2018

Based on observation and interview, the Hospital failed to ensure that public signage clearly specified that there was no Emergency Department at the Women and Children's Hospital campus and that the information was posted in areas likely to be noticed by individuals coming to the campus or entering the building. Failure to effectively educate and notify the public of the absence of emergency services delayed access to care, and risked patient health. Findings were: During Tour of the Women and Children's Hospital campus on 12/13/18 at 12:30 PM, it was noted that signage outside the hospital, readily seen by the public, specified "Women and Children's Hospital." There was no signage information that Emergency Services were not available at the campus.

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Based on observation and interview, the Hospital failed to ensure that public signage clearly specified that there was no Emergency Department at the Women and Children's Hospital campus and that the information was posted in areas likely to be noticed by individuals coming to the campus or entering the building. Failure to effectively educate and notify the public of the absence of emergency services delayed access to care, and risked patient health. Findings were: During Tour of the Women and Children's Hospital campus on 12/13/18 at 12:30 PM, it was noted that signage outside the hospital, readily seen by the public, specified "Women and Children's Hospital." There was no signage information that Emergency Services were not available at the campus. Staff interview verified the signage information. Review of 41 days of the "Walk-in Log" (dated 8/30/18 to 10/9/18) documented 23 entries of people seeking medical care who entered the building. The hospital failed to effectively educate and notify the public of the absence of emergency services at the Women and Children's Hospital campus.

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EMERGENCY ROOM LOG

Dec 14, 2018

Based on observations and interviews, the hospital failed to ensure that all individuals who arrived at the Women and Children's Hospital seeking Emergency Care were registered in a Log with pertinent information and documentation of their condition and disposition as determined by a qualified staff member. Failure to log these patients risked losing important information as to the number of patients arriving at the Women and Children's Hospital for emergency care, their care needs, and disposition. Findings were: During interview with the Security Guard at the Women and Children's Hospital campus on 12/13/18 at 12:40 PM, it was revealed that the "Walk In Disposition Log" that staff previously used to document each patient arriving and seeking medical care had been discontinued.

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Based on observations and interviews, the hospital failed to ensure that all individuals who arrived at the Women and Children's Hospital seeking Emergency Care were registered in a Log with pertinent information and documentation of their condition and disposition as determined by a qualified staff member. Failure to log these patients risked losing important information as to the number of patients arriving at the Women and Children's Hospital for emergency care, their care needs, and disposition. Findings were: During interview with the Security Guard at the Women and Children's Hospital campus on 12/13/18 at 12:40 PM, it was revealed that the "Walk In Disposition Log" that staff previously used to document each patient arriving and seeking medical care had been discontinued. He stated that an email issued by the Director of the Family Birth Center on 10/26/18 directed that, "No logging of people who present to entrance needs to be kept any longer." He stated there was a case (Patient #25) that required 911 to be called on 12/6/18. There was no log entry for Patient #25: He stated the patient had been found "down" and unresponsive on the Women and Children's Hospital Campus on 12/6/18 by a passer-by who came in seeking assistance. The Security Guard called 911 per the new algorithm issued 10/26/18, and the patient was transported by ambulance to the Trios Southridge ED where they were provided a medical screening exam and treatment. The patient was admitted for on-going care. Review of 41 days of the "Walk-in Log" (dated 8/30/18 to 10/9/18) documented 23 entries of people who entered the building. seeking medical care. There was no current record of the number of patients seeking care, their condition on arrival, or their disposition to receive care.

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MEDICAL SCREENING EXAM

Dec 14, 2018

Based on review of hospital policy and procedure, record review and staff interview, the hospital failed to appropriately assess and stabilize a mental health patient prior to sending them to the Mental Health Crisis Office (Patient #26); failed to ensure that individuals entering the building seeking medical assistance were initially screened by qualified staff; and failed to specify in hospital regulations or bylaws which medically qualified personnel had been determined qualified to conduct emergency medical screening exams (MSEs).

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Based on review of hospital policy and procedure, record review and staff interview, the hospital failed to appropriately assess and stabilize a mental health patient prior to sending them to the Mental Health Crisis Office (Patient #26); failed to ensure that individuals entering the building seeking medical assistance were initially screened by qualified staff; and failed to specify in hospital regulations or bylaws which medically qualified personnel had been determined qualified to conduct emergency medical screening exams (MSEs). Failure to provide screening by a qualified staff member as defined by the Hospital's Governing Body, risked patient health and safety. Findings were: Review of the hospital's policy and procedure titled "Patient Transfers (Evaluation, Stabilization, and Transfer) EMTALA" [Emergency Medical Treatment and Labor Act], Policy #KGH 9 Revised 08/17 showed that any individual who presented to the Women's and Children's Hospital (Auburn Campus) and requested or had a request made on his or her behalf for an examination or treatment of a medical condition; or presented with appearance or behavior suggesting the individual needed emergency treatment, would be assessed by "qualified medical personnel." The definition of "qualified medical personnel" included a physician, registered nurse, advanced registered nurse practitioner, physician's assistant, or certified registered nurse anesthetist. Qualified medical personal would initiate treatment to stabilize the patient, call an ambulance to arrange transfer of the patient to a facility that could meet the medical needs of the patient, call the emergency physician on duty at the Southridge campus, and notify the hospital supervisor. 1. Failed to appropriately assess and stabilize a mental health patient prior to sending them to the Mental Health Crisis Office for 1 of 1 mental health patients reviewed (Patient #26). Review of the Women and Children's Hospital Walk In Disposition Log documented that Patient #26 was a mental health patient who arrived seeking Mental Health assistance on 9/26/18 at 8:40 AM with her boyfriend. The House Supervisor provided initial screening and contacted the Mental Health Crisis Office who spoke by phone with the boyfriend. The Office recommended that the boyfriend take the patient to the Crisis Office. No medical screening exam was provided to rule out an emergency medical condition. The hospital failed to assess and stabilize the patient prior to discharge. 2. Failed to have procedures formulated, implemented and reviewed; and Failed to provide qualified staff for initial screening During a tour of the Women and Children's hospital on [DATE], the Security guard was asked how walk-in patients looking for emergency services were handled. He showed the investigator an email from the Director of the Family Birth Center and algorithm dated 10/26/18 which directed that individuals who arrived looking for emergency care at the Women and Children's Hospital would no longer be assessed by a clinical staff member. Review of the email issued 10/26/18 showed that the patients who arrived looking for emergency care were to be interviewed by the security guard on duty: If the patient stated she was pregnant, the patient would be taken to the Family Birth Center unit located in the building. If the patient stated he or she was not pregnant, the security guard was to ask the patient what the person needed. The security guard was to determine if the presenting problem was a "minor problem" or a "serious problem." If the security guard determined it was a "minor problem," the patient would be given a map and instructions regarding how to get to the Southridge campus emergency department, which was five miles away. If the security guard determined the patient had a "serious problem," the guard was to call 911 for an ambulance. If an ambulance was summoned, the guard was to call the Family Birth Center, and a nursing staff member would "come and sit with the patient" until the ambulance arrived. The individual was not to be taken to the Family Birth Center and "put in a bed." If the individual had a cardiac arrest, the security guard was to begin cardiopulmonary resuscitation and call 911. He stated there was a case (Patient #25) that required 911 to be called on 12/6/18. He stated the patient had been found "down" and unresponsive on the Women and Children's Hospital Campus on 12/6/18 by a passer-by who came in seeking assistance. The Security Guard called 911 per the new algorithm issued 10/26/18, and the patient was transported by ambulance to the Trios Southridge ED where they were provided a medical screening exam and treatment. The patient was admitted for on-going care. On 12/14/18 at 9 AM during an interview, the interim nursing director stated the entire procedure was currently under review by administration and medical staff, but remained in rough draft form. No changes had been made from the revised directive dated 10/26/18. 3. Failed to have language in by-laws, approved by the Governing Body that specified which medically qualified personnel had been determined qualified to conduct emergency medical screening exams (MSEs). Review of Hospital Regulations failed to evidence language that specified which medically qualified personnel had been determined qualified to conduct emergency medical screening exams (MSEs). Staff interview on 12/14/18 verified that there was no specific directive in Hospital Regulations or Bylaws.

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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.