ED practice can be a rewarding professional choice. However, it is no easy calling. It requires quick decision-making, masterful patient assessment, and capable and current skill sets. It has its challenges, too, including treating all types of health issues.
One ever-present challenge is ensuring patients who present at the ED with nonemergency problems are cared for with the same efficiency as those with emergency conditions.
According to a recent online article, “Making the ER More Efficient,” on Medpage Today, this goal requires an optimization of ED services. Evaluating the entire process of providing what is needed for ED patients is essential. Rather than a focus on clearing the ED so no bottlenecks occur, the emphasis should be on the entire process, according to the author, Michael Zeis. It starts when a patient comes into the ED and ends with a transfer of the patient to an appropriate care setting, as needed.
The emphasis should be on a more streamlined approach to patient care for all patients who come into an ED. ED nurses cannot forget the facility’s and their own obligations under the Emergency Medical Treatment and Active Labor Act. Passed by Congress in 1986, the act prohibits facilities that receive Medicare and Medicaid funding from dumping patients out of EDs when they cannot pay for care.
What does EMTALA require?
EMTALA requires an ED to screen a patient for a medical condition and stabilize that condition. Should a transfer be necessary, it can occur only after the condition is stabilized, and:
-Informed consent is obtained for the transfer;-
-There is a facility to accept the patient transfer; and
-A physician certifies certain factors supporting the transfer.
EMTALA also defines a medical condition as one that with acute symptoms which, if not treated, could result or reasonably be expected to result in serious jeopardy to the health of the patient, serious impairment of bodily functions and serious dysfunction of any body part. With a woman in active labor, a medical condition is defined by whether there is insufficient time to safely transfer the patient or if the transfer may pose a risk to both the patient and the fetus (42 U.S.C. Section 1395dd(e)(1)).
Consequences of violations
Violations of EMTALA can result in termination of the ED receiving funds from Medicare and Medicaid, civil penalties against the ED, and a suit for personal injuries under applicable state laws.
As an ED nurse, you should:
-Participate in the establishment of policies and procedures governing the nurse’s role in the assessment and treatment of patients;
-Adhere to established policies and procedures;
-Adhere to the EMTALA mandates;
-Document truthfully and completely all decisions concerning patient care, transfers or noncore;
-Advocate for patients by immediately reporting any decisions inconsistent with EMTALA to the ED nurse manager and file an incident report with risk management.
NOTE: Nancy Brent’s posts are designed for educational purposes and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.