EMTALA

Steps should Emergency Department physicians take to ensure that patient transfers from the hospital are safe, and are in full compliance with (EMTALA)

Steps should Emergency Department physicians take to ensure that patient transfers from the hospital are safe, and are in full compliance with (EMTALA)

EMTALA! ” IT'S NOT EVEN A REAL WORD, but it strikes fear in every practicing emergency physician. Its meaning can range far and wide. It can mean having to see the patient who has had a rash for the last 6 months and decided to come to the emergency department (ED) at 2 AM. It can mean trying to getting a consultant to come see a patient without revealing their insurance (or lack of) status. It can even mean having to worry if those last three walkouts will file a complaint that will bring a sudden surprise inspection to your hospital. Where did EMTALA come from? What changes are in store for it in the future?

Under the previous guidelines, a patient was defined as having “come” to the ED if they presented asking for evaluation and/or treatment anywhere on the main hospital campus, within 250 yards of the main hospital (with exceptions), at any off-campus hospital department, or when riding in a hospital-owned ambulance. Under the new rules, a patient would be considered to have come to the ED if they present to a “dedicated” ED or “attempt” (Little, Boniface, 2005) to gain access to the ED from anywhere else on the hospital property.

CMS also has broadened the rule as to what constitutes a request for an emergency evaluation. In addition to the patient (or representative) making a specific request for care, they have proposed a “prudent layperson” standard in determining when an EMTALA duty is initiated. A request for care would be initiated if by behavior or appearance a prudent layperson (eg, a hospital staff member) believed that the individual needed emergency care.

CMS has also liberalized how non-emergency patients may be handled in the ED. If the nature of the patient's complaint makes it clear that they do not have an EMC, an appropriate MSE only needs to confirm it. In the past, CMS has been clear that triage and the MSE are separate processes. It has generally discouraged hospitals from using triage nurses as “qualified medical personnel” who may perform a MSE(Kreshak, Mariani, 2006). In its comments for the new rules, CMS seems to ...