NANCY J. BRENT MS, JD, RN
E
ED nurses tend to all types of health issues
D 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. One ever-present challenge is ensur-
ing 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 op- timization 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.
Streamlined approach The emphasis should be on a more stream- lined approach to patient care for all pa- tients 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 facil- ities 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 sta- bilize that condition. Should a transfer be necessary, it can occur only after the condition is stabilized, and: 1.
Informed consent is obtained for the transfer;
2. There is a facility to accept the patient transfer; and
3. A physician certifies certain factors supporting the transfer.
EMTALA also defines a medical condi-
tion 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 ter- mination of the ED receiving funds from Medicare and Medicaid, civil penalties against the ED, and a suit for personal in- juries under applicable state laws. As an ED nurse, you should: 1. Participate in the establishment of policies and procedures governing the nurse’s role in the assessment and treatment of patients;
2. Adhere to established policies and procedures;
3. Adhere to the EMTALA mandates; 4. Document truthfully and com- pletely all decisions concerning patient care, transfers or noncare;
5. Advocate for patients by immediate- ly reporting any decisions inconsis- tent with EMTALA to the ED nurse manager and file an incident report with risk management. •
Nancy J. Brent, JD, RN, MS, is
Nurse.com’s legal information columnist and an attorney in private practice. This article is for educational purposes only and is not to be taken as specific legal or other advice.
24 Visit us at
NURSE.com • 2016
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