UMC adjusting patient care procedures in emergency room


Evelyn Lundell, the clinical manager in the University Medical Center emergency department, scrolled down her computer Thursday and saw two cases that UMC Quick Care doctors were transferring to the hospital emergency staff.

“This is excellent,” she said. “We can see what tests they’ve had already. After they get here, we can get them the help they need in no time.”

That kind of information sharing, now made by computer through the hospital’s Patients Placement Center, wasn’t available in November when 25-year-old Roshunda Abney was treated for abdominal pain and a suspected pregnancy at a Quick Care before being transferred to UMC’s emergency room.

Instead, according to Brian Brannman, UMC’s chief operating officer, a Quick Care representative followed the normal protocol — trying to reach the emergency room charge nurse by phone.

“But she was busy on two cardiac cases,” Brannman said.

When Abney arrived at UMC on Nov. 30, the busy emergency room staff didn’t know her situation nor did they look at paperwork she brought with her from the Quick Care. Despite her cries of agony and repeated attempts by her fiance and others in the emergency room to get UMC personnel to come to her aid, nothing was done for her.

“We want to make sure that kind of thing doesn’t happen again,” Brannman said.

Better use of computer technology is only one of the changes UMC has made since the Review-Journal first reported Abney’s ordeal.

Since then, following state and federal investigations, the hospital has put into place a series of corrective actions to offset “deficiencies” listed in the probes. The actions include removing certified nursing assistants from all assessment work, and putting in place early triage by a registered nurse.

“We have also had training to remember to always respect a patient’s pain,” said Lundell, adding that even security guards have been trained to identify people who seem to be suffering.

The Nevada State Health Division, whose surveyors did the probes for the state and the federal Centers for Medicare and Medicaid Services, has already accepted the hospital’s correction plan that was initiated last month.

CMS is expected to sign off on the plan, said Brannman, who added that “this is the usual course of action” when deficiencies are found at a hospital.

Jack Cheevers, a CMS spokesman, said that surveyors will make an unannounced visit in the next month to ensure that a correction plan is in place.

A Jan. 29 letter to UMC from CMC warns that if the plan does not pass muster, Medicare payments, which totalled about $180 million through the first three quarters of 2009, could be halted April 29.

It could happen, but it’s unlikely.

“We don’t close hospitals willy nilly,” Cheevers said.

Other Las Vegas Valley hospitals have received similar warning letters from CMS if they didn’t correct deficiencies.

When Abney arrived at the hospital shortly after 6 p.m., a physician had already left his station near the waiting room. Under the corrective plan, a physician will remain on duty there until 3 a.m. with nurses “for rapid assessment” duties, Lundell said.

Dr. Dale Carrison, head of emergency services at UMC, outlined Thursday how a typical visit to the emergency room should go.

When patients sign in, they should remember to write down their chief complaint. If they’re in real distress, they should tell the registered nurse.

“That nurse can then take steps immediately,” Carrison said.

In the past, he said, a certified nursing assistant would have to find a nurse or a doctor to do an assessment.

“We’ve cut out a step,” he said.

The nurse, Carrison said, may send the patient to the doctor stationed next to the waiting room, who can immediately order tests and lab work.

“Of course, if someone is in really bad shape, all steps are cut out and the patient is taken back immediately,” Carrison said.

Brannman cautioned people against thinking that everyone who comes to the emergency room will be put on a fast track for care.

“If it’s not a real emergency and someone is using us basically for a doctor’s visit, they’re still going to wait a long, long time,” he said. “That’s the way it is all over the United States. We just want to make that we take care of true emergencies the right way.”

To this day, Carrison said that what happened to Abney makes him sick to his stomach. Six employees were suspended as a result of her lack of treatment.

The couple eventually gave up hope of being seen at UMC and went to nearby Valley Hospital, where they say they were rebuffed.

Valley Hospital officials deny its employees were unhelpful.

Abney went home and gave breech birth to a baby girl, who died. Abney said she did not realize she was pregnant.

“Had the policies already in place been followed, the incident would not have occurred,” Carrison said. “Let’s face it, if somebody doesn’t choose to follow the rules the system will fail no matter what it is.”

 

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.

 

Rules for posting comments

Comments posted below are from readers. In no way do they represent the view of Stephens Media LLC or this newspaper. This is a public forum. Read our guidelines for posting. If you believe that a commenter has not followed these guidelines, please click the FLAG icon next to the comment.