HCA Florida Fawcett Hospital

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 25618 Based on staff interviews and record review the facility failed to ensure one, (Patient #2), of 20 patients reviewed seeking emergency care was provided an appropriate medical screening examination (MSE) to any individual who comes to the emergency department. The findings included: Review of the Emergency Department (ED) Triage Policy #DP-780-319 with a reviewed date of 10/2024 stated the purpose of this policy was to define guidelines and responsibilities of the Emergency Department triage nurse. The hospital had established guidelines for the nurses who triaged patients and their responsibilities to the patient. Under the Reassessment Guidelines section, it stated a reassessment will be ongoing throughout the patient’s visit, to recognize changes in the patient’s condition, and prior to the medical screening exam, the patient will be reassessed, at a minimum of every 60 minutes and as condition warrants by the triage nurse. Review of the Emergency Department Medical Screening Examination and Stabilization Policy #P-30-041-FL with a review date of 8/24 stated the purpose of the policy was to establish guidelines for providing appropriate medical screening examination and any necessary stabilizing treatment or an appropriate transfer for the individual as required by EMTALA (Emergency Medical Treatment and Labor Act). Under the section Extent of the MSE it stated, “c. An on-going process. The individual shall be continuously monitored according to the individual’s needs until it is determined whether or not the individual has an EMC, and if her or she does, until the EMC (emergency medical condition) is relieved or eliminated or the individual is appropriately admitted or transferred. The medical record shall reflect the amount and extent of monitoring that was provided prior to the completion of the MSE and until discharge or transfer.” Review of the Emergency Department Care Guidelines-Emergency Department Policy #DP-780-107 stated the purpose of this policy “is to guide staff on how to care for patients who come into the Emergency Department seeking evaluation and treatment.” The assessment and reassessment guidelines stated staff was to “assess patients to determine triage priority as soon as possible after the patient’s arrival” The policy stated the assessment was to include airway, breathing, circulation, disability and exposure/environmental changes... D. Documentation would be completed by the triage RN (Registered Nurse), Charge RN or primary nurse as appropriate to include the chief complaint, vital signs (temperature, pulse, respiration and oxygen (O2) saturation on all patients ... H. Document and communicate assessment findings to the provider and/or other healthcare providers. Under the section Vital Sign Monitoring II. A. stated the vital signs (V/S) “take and record base on triage acuity and/or condition”, ... “B. and report abnormal V/S to provider when: 1. Temperature >38 C (100.4 F) or <36 C (96.8 F), 2. blood pressure (B/P) systolic >180 or <90, 3. Oxygen saturation <92%, 4. heart rate >120 or <50, or irregular pulse, and 5. Respiratory rate >25 or <12 ... D. All patients will have vital signs documented within 1 hour of admission and discharge and E. All patients will have vital signs documented within 15 minutes of transfer.” On 9/9/25 a review of Patient #2’s emergency room medical record revealed he arrived at the emergency department on 7/10/25 at 12:16 p.m. and triaged at 12:21 p.m. with a chief complaint of Fever/Flu like symptoms. The admitting v/s taken at 12:17 p.m. included temperature 100.5, pulse 85, respiratory rate 18, blood pressure 176/75 and oxygen saturation (SPO2) rate 97%. The history of present illness (HPI) stated a 56-year-old male with a history of end-stage renal disease on peritoneal dialysis, complaining of a temperature of 103 for the last 24 hours. The patient stated that he had been taking Tylenol every 5-6 hours which did bring down his fever. Patient stated that when he had a temperature of 103 his fever gave him a lot of acid indigestion and increased burping. The emergency room provider, an Advance Registered Nurse Practitioner (ARNP) documented on 7/10/25 at 12:19 p.m. that Patient #2 was diagnosed with viral syndrome. Further review of Patient #2’s emergency room medical record revealed Patient #2 was documented as departing the emergency room at 1:10 p.m. The medical record noted the admitting v/s documented at 12:17 p.m. noted Patient #2 had an elevated temperature of 100.5. The medical record did not reveal Patient #2’s v/s to include a temperature was reevaluated prior to their discharge from the emergency room at 1:10 p.m. On 9/9/25 at around 10:00 a.m., an interview with Patient #2 significant partner said she brought Patient #2 to the emergency room department due to his temperature being higher than 103 degrees. She stated Patient #2 had taken several doses of Tylenol over the past 24 hours to lower his temperature. She said they were in the emergency room department for almost an hour. She said when they arrived to the emergency room department hospital staff checked Patient #2’s v/s and conducted an influenza A and B, COVID and step tests which all came back negative. She said she had asked hospital staff if they could run blood tests on Patient #2 due to his history of kidney failure and currently on peritoneal dialysis at home. She said they were worried the continuously high elevated temperatures could be related to his peritoneal dialysis. She said the emergency room staff took Patient #2’s vital signs (v/s) when he arrived to the emergency room in triage but did not retake his v/s when he was discharged home almost an hour later. She said the emergency room staff did not give them a reason why they did not conduct further bloodwork as requested by the patient and significant other, prior to his (Patient #2) discharge home, but told him to return to the emergency room if his systems got worse. She said Patient #2 returned to the emergency room the next day due to worsening conditions and was admitted to the hospital. On 9/9/25 at around 3:20 p.m., in an interview with the Director of Risk Management (DRM) and Director of Quality (DOQ), they confirmed Patient #2’s medical record documented he came to the emergency room department on 7/10/25. The time stamp noted Patient #2 was seen by reception at 12:16 p.m., triaged and room assigned at 12:21 p.m., disposition of discharge at 1:07 p.m. and departed the emergency room at 1:10 p.m. They confirmed the medical records noted Patient #2’s emergency room medical record documented the triage nurse had written on 7/10/25, the chief complaint was a fever of greater than 103, and Patient #2 had told them he had been taking Tylenol over the past 24 hours to control the high temperature and had a history of end-stage renal disease on peritoneal dialysis. They stated the initial v/s taken at 12:17 p.m. documented a temperature of 100.5, pulse 85, respiratory rate 18, blood pressure 176/75 and oxygen saturation (SPO2) 97%, and the influenza A and B, COVID swabs, and strep culture test all came back negative. They confirmed the facility’s the Emergency Department Care Guidelines-Emergency Department Policy #DP-780-107 noted an assessment and reassessment guidelines stated the patient were assessed to determine triage priority as soon as possible after the patient’s arrival to include airway, breathing, circulation, disability and exposure/environmental changes. Documentation would be completed by the triage RN (Registered Nurse), Charge RN or primary nurse as appropriate to include the chief complaint, vital signs (temperature, pulse, respiration and O2 saturation on all patients). Document and communicate assessment findings to the provider and/or other healthcare providers. Under the section Vital Sign Monitoring, the policy stated the vital sign (V/S) taken and recorded base on triage acuity and/or condition, and report abnormal V/S when: temperature >38 C (100.4 F) or <36 C (96.8 F), blood pressure (B/P) systolic >180 or <90, oxygen saturation <92%, hear rate >120 or <50 or respiration rate >25 or <12. All patients would have vital signs documented within 1 hour of admission and discharge and within 15 minutes of transfer. The DRM and DOQ confirmed Patient #2’s temperature of 100.5 degrees during triage was considered abnormal per their policy Emergency Department Policy #DP-780-107. They confirmed Patient #2’s medical record did not reveal/document a second set of v/s were taken prior to Patient #2’s discharge from the emergency department at 1:10 p.m. to ensure Patient #2’s v/s were within the required parameters prior to his discharge from the emergency department. They also confirmed the emergency department had not conducted other diagnostic tests to include but not limited to a CBC (complete blood count, CMP (complete metabolic panel), lactate and/or blood cultures for a patient with a history of end-stage renal disease on peritoneal dialysis who had taken Tylenol prior to coming to the emergency department for fever greater than 103 degrees for the past 24 hours.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 25618 Based on staff interviews and record reviews, the facility failed to ensure one, (Patient #2), of 20 patients reviewed seeking emergency care were provided appropriate medical screening examination (MSE) of a dialysis patient with an abnormal temperature of 100.5 degrees and reassessment of an abnormal temperature prior to their discharged home from the emergency department. The findings included: Review of the Emergency Department Medical Screening Examination and Stabilization Policy #P-30-041-FL with a review date of 8/24 stated the purpose of the policy was to establish guidelines for providing appropriate medical screening examination and any necessary stabilizing treatment or an appropriate transfer for the individual as required by EMTALA (Emergency Medical Treatment and Labor Act). Under the section Extent of the MSE it stated, “c. An on-going process. The individual shall be continuously monitored according to the individual’s needs until it is determined whether or not the individual has an EMC, and if her or she does, until the EMC (emergency medical condition) and if he or she does, until the EMC is relieved or eliminated or the individual is appropriately admitted or transferred. The medical record shall reflect the amount and extent of monitoring that was provided prior to the completion of the MSE and until discharge or transfer.” Review of the Emergency Department Care Guidelines-Emergency Department Policy #DP-780-107 stated the purpose of this policy “is to guide staff on how to care for patients who come into the Emergency Department seeking evaluation and treatment.” The assessment and reassessment guidelines stated staff was to “assess patients to determine triage priority as soon as possible after the patient’s arrival” The policy stated the assessment was to include airway, breathing, circulation, disability and exposure/environmental changes... D. Documentation would be completed by the triage RN (Registered Nurse), Charge RN or primary nurse as appropriate to include the chief complaint, vital signs (temperature, pulse, respiration and oxygen (O2) saturation on all patients ... H. Document and communicate assessment findings to the provider and/or other healthcare providers. Under the section Vital Sign Monitoring II. A. stated the vital signs (V/S) “take and record base on triage acuity and/or condition”, ... “B. and report abnormal V/S [vital signs] to provider when: 1. Temperature >38 C (100.4 F) or <36 C (96.8 F), 2. blood pressure (B/P) systolic >180 or <90, 3. Oxygen saturation <92%, 4. heart rate >120 or <50, or irregular pulse, and 5. Respiratory rate >25 or <12 ... D. All patients will have vital signs documented within 1 hour of admission and discharge and E. All patients will have vital signs documented within 15 minutes of transfer.” On 9/9/25 a review of Patient #2’s emergency room medical record revealed he arrived to the emergency department on 7/10/25 at 12:16 p.m. and triaged at 12:21 p.m. with a chief complaint of Fever/Flu like symptoms. The admitting v/s (vital signs) taken at 12:17 p.m. included temperature 100.5, pulse 85, respiratory rate 18, blood pressure 176/75 and oxygen saturation (SPO2) rate 97%. The history of present illness (HPI) stated a 56-year-old male with a history of end-stage renal disease on peritoneal dialysis, complaining of a temperature of 103 for the last 24 hours. The patient stated that he had been taking Tylenol every 5-6 hours which did bring down his fever. Patient stated that when he had a temperature of 103 his fever gave him a lot of acid indigestion and increased burping. The emergency room provider, an Advance Registered Nurse Practitioner (ARNP) documented on 7/10/25 at 12:19 p.m. that Patient #2 was diagnosed with viral syndrome. The ARNP noted that all laboratory, imaging studies and other diagnostic studies were ordered and reviewed and independently interpreted by the ARNP. The ARNP discussed the results of the patient’s emergency department workup/examination today with the patient and/or family/caregiver. The ARNP explained at this time there was no evidence of any acute life-threatening or emergent process or finding that requires admission to the hospital or further emergent treatment. Further review of Patient #2’s emergency room medical record revealed Patient #2 was documented as departing the emergency room at 1:10 p.m. The medical record noted the admitting v/s documented at 12:17 p.m. noted Patient #2 had an elevated temperature of 100.5. The medical record did not reveal additional diagnostic studies to rule out a potential infection related to peritoneal dialysis. Additionally, Patient #2’s vital signs did not include a temperature was reevaluated prior to their discharge from the emergency room at 1:10 p.m. On 9/9/25 at around 10:00 a.m., an interview with Patient #2 significant partner said she brought Patient #2 to the emergency room department due to his temperature being higher than 103 degrees. She stated Patient #2 had taken several doses of Tylenol over the past 24 hours to lower his temperature. She said they were in the emergency room department for almost an hour. She said when they arrived to the emergency room department hospital staff checked Patient #2’s v/s and conducted an influenza A and B, COVID and step tests which all came back negative. She said she had asked hospital staff if they could run blood tests on Patient #2 due to his history of kidney failure and currently on peritoneal dialysis at home. She said they were worried the continuously high elevated temperatures could be related to his peritoneal dialysis. She said the emergency room staff took Patient #2’s v/s when he arrived to the emergency room in triage but did not retake his v/s when he was discharged home almost an hour later. She said the emergency room staff did not give them a reason why they did not conduct further bloodwork as requested by the patient and significant other, prior to his (Patient #2) discharge home, but told him to return to the emergency room if his systems got worse. She said Patient #2 returned to the emergency room the next day due to worsening conditions and was admitted to the hospital. On 9/9/25 at around 3:20 p.m., in an interview with the Director of Risk Management (DRM) and Director of Quality (DOQ), they confirmed Patient #2’s medical record documented he came to the emergency room department on 7/10/25. The time stamp noted Patient #2 was seen by reception at 12:16 p.m., triaged and room assigned at 12:21 p.m., disposition of discharge at 1:07 p.m. and departed the emergency room at 1:10 p.m. They confirmed the medical records noted Patient #2’s emergency room medical record documented the triage nurse had written on 7/10/25, the chief complaint was a fever of greater than 103, and Patient #2 had told them he had been taking Tylenol over the past 24 hours to control the high temperature and had a history of end-stage renal disease on peritoneal dialysis. They stated the initial v/s taken at 12:17 p.m. documented a temperature of 100.5, pulse 85, respiratory rate 18, blood pressure 176/75 and oxygen saturation (SPO2) 97%, and the influenza A and B, COVID swabs, and strep culture test all came back negative. They confirmed the facility’s the Emergency Department Care Guidelines-Emergency Department Policy #DP-780-107 noted an assessment and reassessment guidelines stated the patient were assessed to determine triage priority as soon as possible after the patient’s arrival to include airway, breathing, circulation, disability and exposure/environmental changes. Documentation would be completed by the triage RN (Registered Nurse), Charge RN or primary nurse as appropriate to include the chief complaint, vital signs (temperature, pulse, respiration and O2 saturation on all patients. Document and communicate assessment findings to the provider and/or other healthcare providers. Under the section Vital Sign Monitoring, the policy stated the vital sign (V/S) taken and recorded base on triage acuity and/or condition, and report abnormal V/S when: temperature >38 C (100.4 F) or <36 C (96.8 F), blood pressure (B/P) systolic >180 or <90, oxygen saturation <92%, hear rate >120 or <50 or respiration rate >25 or <12. All patients would have vital signs documented within 1 hour of admission and discharge and within 15 minutes of transfer. The DRM and DOQ confirmed Patient #2’s temperature of 100.5 degrees during triage was considered abnormal per their policy Emergency Department Policy #DP-780-107. They confirmed Patient #2’s medical record did not reveal/document a second set of v/s were taken prior to Patient #2’s discharge from the emergency department at 1:10 p.m. to ensure Patient #2’s v/s were within the required parameters prior to his discharge from the emergency department. They also confirmed the emergency department had not conducted other diagnostic tests to include but not limited to a CBC (complete blood count, CMP (complete metabolic panel), lactate and/or blood cultures for a patient with a history of end-stage renal disease on peritoneal dialysis who had taken Tylenol prior to coming to the emergency department for fever greater than 103 degrees for the past 24 hours.”