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Central Pennsylvania Hospital Cited For Emergency Room Procedure Flaws – Impacts Patient Safety

Dave Wenner of the Harrisburg Patriot News reports today on problems with the emergency department at a local central Pennsylvania hospital, just south of Harrisburg.  According to the article, several patients have not received prompt treatment when going to the emergency room.  Do you think this is good for patient safety?  Below is the full article which can also be found at:

A 48-year-old man walked into Carlisle Regional Medical Center in April complaining of a burning in his leg. He walked out six hours later because he was tired of waiting for medical care. It turns out he hadn’t even received a full assessment of how sick he might have been.

The incident is outlined in a Pennsylvania Department of Health report that said Carlisle Regional failed to adequately access the medical conditions of numerous people who came to its emergency room this spring. The report further said 19 patients walked out of Carlisle Regional’s emergency room May 12 and 13 without receiving treatment, with at least some walking out because they felt the hospital was slow in providing medical care.

In addition, the health department said Carlisle Regional failed to promptly address grievances involving emergency department patients in April. The department is requiring Carlisle Regional to carry out a long list of changes, including revising its procedures for evaluating emergency room arrivals.

“Carlisle Regional Medical Center takes the findings of a recent state Department of Health report very seriously. Our focus remains on the high-quality care our dedicated team of physicians, nurses and health care professionals provide every day to the patients and families we serve,” spokeswoman Tara Mead said. “We continue to be very focused on improving the efficiency and effectiveness of our emergency room operations and we realize that no one wants to wait in an emergency.”

The problems were found following an unannounced investigation that followed a complaint and was completed on May 21.

According to the health department, Carlisle Regional’s policy calls for a registered nurse to evaluate the conditions of new emergency department arrivals. The evaluation includes obtaining information on things such as the patient’s medical history, chief complaint, allergies and medications, and vital signs, which include heart and breathing rates, temperature and blood pressure. The evaluation is part of a process called triage, which refers to prioritizing patients based on the severity of their condition.

The department found that Carlisle Regional’s electronic medical records system declared triage complete following input of three items: the patients mode of arrival, chief complaint and acuity level, which refers to severity of illness. A Carlisle Regional employee acknowledged the hospital’s policy calls for additional information, such as vital signs and allergies and medications. She stated that “We had not been aware of that feature of the system that declares triage complete based on input of only three items,” according to the health department.

The health department report goes on to outline the case of the 48-year-old man who came to the emergency room in early April complaining of a the burning in his leg. He arrived at 6:53 p.m. and his record listed triage as being complete at 6:55 p.m. The health department said the man left at 1:02 a.m. due to wait time. It said his record lacked documentation of a complete triage evaluation.

The department further said that for seven of the 19 emergency room patients who left without treatment there was no evidence that the level of triage called for in Carlisle Regional’s policy had been completed.

Carlisle Regional agreed to a long list of items to address the situation. These include revising policies to better define the triage process and staff responsibilities during triage, randomly selecting the charts of 10 patients per month to determine whether the revised policies are being followed, and following up with patients who leave without treatment to understand why they left and how they are doing.

Mead also said Carlisle Regional recently hired a new emergency room director, although the move wasn’t directly related to problems cited by the health department.

The health department also faulted Carlisle Regional for its handling of patient grievances. The department said Carlisle Regional’s policy defines grievances as complaints by patients that can’t be resolved by staff on the spot. Grievances include complaints made to the hospital after the patient leaves.

Carlisle Regional’s policy calls for a patient who complains to receive a written response within seven days. If, at the time of the first notice, the grievance is still unsolved, the patient should receive a second written notice within 14 days.

The health department said it reviewed the nine emergency department complaints made during April. In each case, the first written response was sent eight days after the initial complaint, rather than seven. The department further said that in each case, Carlisle Regional informed the patient the investigation and resolution of their complaint would take longer than seven days and that every effort is being made to resolve their concerns as soon as possible. In each case, the patient also was told they would receive a final response by a specified date.

In five of the nine cases, the specified date came and went without the patient being informed of how their complaint was resolved, the department said. Carlisle Regional has re-trained managers on handling of grievances, and taken additional steps including conducting weekly meetings to review all outstanding complaints and grievances, the department said.

Carlisle Regional was not fined.

The latest incidents are more bumps in a rough road for Carlisle Regional that began last summer with a scathing investigation report from the health department that focused on low staffing levels and long emergency room waits. The department originally stated that two patient deaths might have been related to low staffing, but later backed off and said there was no evidence the patient deaths were related to inadequate medical care. However, Carlisle Regional agreed to take assorted steps including hiring more nurses and other staff.

Carlisle Regional, which is the Harrisburg region’s only for-profit hospital, hit another bump late last year when the independent Joint Commission found 23 problems and withheld it accreditation. However, Carlisle Regional addressed the problems and received an endorsement from the Joint Commission in March.

Prior to the recently disclosed inspection results, the health department had inspected Carlisle Regional at least six times this year and found no problems.

Carlisle Regional, based in South Middleton Twp., handles about 30,000 emergency room visits per year.

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