Delayed Radiology and Diagnostic Services for Two Residents
Penalty
Summary
Facility staff failed to provide or obtain timely radiology and diagnostic services for two residents, resulting in deficiencies related to delayed x-ray procedures. In the first case, a resident with multiple diagnoses, including dementia, hypertension, and chronic kidney disease, experienced a fall and complained of left hip pain. Although a provider ordered a left hip x-ray the day after the fall, the x-ray was not performed as scheduled due to a delay by the mobile x-ray company, which did not arrive until two days later. Facility staff did not notify the medical provider of the delay, and documentation inaccurately reflected that the x-ray had been completed. The resident continued to experience pain and was eventually sent to a higher level of care, where a left hip fracture requiring surgical repair was diagnosed. Interviews with staff and family members confirmed that the x-ray was not performed as ordered and that communication with the provider regarding the delay was lacking. The facility's agreement with the mobile x-ray company stipulated availability of radiology services seven days a week, and facility policy required prompt physician notification in the event of changes in condition, such as accidents with potential for physician intervention. Despite these policies, the delay in obtaining the x-ray and the lack of provider notification were not addressed in a timely manner. In the second case, another resident with a history of cerebral infarction, metabolic encephalopathy, and other conditions experienced a choking incident, prompting a provider order for a chest x-ray to rule out aspiration pneumonia. The chest x-ray was not obtained until four days after the order was placed, and there was no documentation explaining the delay. The Director of Nursing confirmed the delay and was unable to provide a reason for it. Facility policy required that radiology and other diagnostic services be provided to meet residents' needs, but this was not followed in this instance.