A state investigation at Tucson’s Northwest Medical Center found several instances where patients in the hospital’s emergency room appear to have been ignored for hours.
In one case, an infant with chicken pox was in a public waiting area for more than three hours, investigators found. In another, the state found, a baby with a high fever, cough and pain had not received even an initial assessment an hour and 45 minutes after arriving in the emergency room.
Last month, hospital officials agreed to pay civil penalties of $1,750 — an amount set by state statute. Among other things, the hospital was fined for emergency room delays that left some patients waiting hours to be triaged, creating a potential health and safety risk, according to the Arizona Department of Health Services, which both licenses the hospital and conducted the investigation.
Other patients were at risk for “outcomes of harm” because they left before they were evaluated or reassessed by a doctor or other primary care provider, the state's report said.
“30 minutes or less”
Northwest Medical Center has a “30 minutes or less” emergency room waiting time pledge, but it was not in effect during the state’s investigation, a hospital spokeswoman said. It’s back in effect now.
Hospital officials said Friday that they are doing better with improved processes.
“Our April ‘door-to-provider’ average was 22 minutes and consistent timeliness has allowed us to reinstate our 30-Minutes-or-Less ER pledge,” a hospital statement says.
“Providing timely triage, assessment and care for emergency room patients is the top priority for caregivers throughout our ER. Over the past six months, we have adopted a new staffing model and processes that have significantly improved our efficiency.”
Triage, an initial determination of the nature and seriousness of the complaint, is normally done with a nurse right after patients arrive.
The most recent federal data show the average time patients spent in the Northwest Medical Center emergency department before seeing a health-care professional (after being triaged) was 39 minutes, which was faster than most other local hospitals. That self-reported data was for July 2013 to July 2014, a time period months before the state investigation.
investigation finds major problems
State investigators visited Northwest’s emergency department on Jan. 14 in response to a complaint and found problems with 16 of 27 cases reviewed, including instances where patient safety was potentially at risk.
Among those cases:
- A woman showed up at the emergency department at 9:26 p.m. on Jan. 9 with abdominal pain, nausea and vomiting. She was triaged two hours after arriving with a pain level documented as eight out of 10, state records show.
The patient, who had visited one of the hospital’s urgent care facilities earlier that day, was assigned a low, “less urgent” acuity level of four. The patient left the emergency department at 1:15 a.m. — nearly four hours after arriving — without having seen a physician, the state report says.
She returned to the emergency room at 6:43 p.m. on Jan. 11 with “severe stomach pain and nausea,” but had gone by the time she was called to triage nearly an hour later, the state found.
She went to another hospital, where she had surgery for three large stones impacted in the neck of her gallbladder. The surgeon’s operative report said there were “gangrenous changes of the gallbladder wall,” state investigators found.
- A baby under the age of 16 months was taken to the emergency room at 5:25 p.m. on Nov. 12 because of “rash, fever, cough,” and was triaged an hour later by a nurse who noted the child had a red rash scattered on the torso and legs.
Those symptoms are consistent with measles or chicken pox, but the the nurse sent the baby back into the waiting room, where she waited until 9 p.m. without being reassessed or evaluated by a physician. At 9:30 a.m. the next day, a nurse practitioner at an urgent care clinic diagnosed the child with chicken pox. A review of the infant’s records revealed that she was past due on her one-year vaccines, investigators found.
An infection control preventionist later told a state investigator that, based on the infant’s symptoms, the nurse should have made efforts to isolate her from the general public and also should have implemented respiratory precautions for the patient.
The preventionist and the manager of the emergency department both acknowledged the infant was in the waiting room for “a period of approximately 3.5 hours where members of the general public were potentially exposed.”
- A woman who was nine weeks pregnant and experiencing bleeding went into the emergency department at 5 p.m. on Jan. 9 and left eight and a half hours later, with no documentation that she was ever triaged, the state report says.
- A woman over the age of 90 arrived in the hospital emergency department at 6:19 p.m. on Jan. 8 with chest pain, and was triaged at 6:33 p.m. Notes included the woman’s history of congestive heart failure.
More than five hours after she arrived, records show the woman had an ECG that revealed an abnormality, but her records don’t indicate a nursing reassessment was performed, the report says. The patient remained in the waiting room until 1 a.m. and then left, the report says.
- A patient came to the emergency department at 10:27 p.m. on Nov. 11 with difficulty breathing and sharp chest pains, the state report says.
The patient was triaged at 10:46 p.m., and told a nurse she had experienced a sudden onset of trouble breathing with gastric burning. The nurse performed a blood draw and got a urine specimen, the state report shows.
State investigators say the patient left the emergency department at 4 a.m. on Nov. 12, about 6½ hours after she was triaged. There was no documentation she was reassessed by the nursing staff or evaluated by a physician during that time, the report says.
Hospital vows issues have been addressed
Incidences like that are in the past, the hospital says.
“Our patients are now effectively triaged and our goal is to have patients initially seen by a medical professional within 30 minutes,” its statement says. “Our caregiving team is focused on service and these changes have enhanced the experience of our ER patients.”
Northwest’s pledge, prominently displayed on its website, is for patients to be evaluated or treated by a physician, physician assistant or nurse practitioner within 30 minutes of arriving.
The hospital started marketing that goal in 2011, but stopped for a period that included the state’s investigation, spokeswoman Kimberly Chimene said. The “30 minutes or less” is a goal, officials say, not a promise.
