Emergency Department EMTALA Education Directions for Completion 1. Before proceeding to the posttest, be sure you have reviewed the PowerPoint program (best viewed as Slide Show). 2. Exit and complete the posttest which is final step of this education. “Take Test” may be a posttest or acknowledgment statement. Remember, no attendance record is needed. Completion of the posttest will be sent electronically to your EduTracker record once a 100% is achieved. 3. Print the Certificate of Completion for your records if desired.

20 Commandments of COBRA/EMTALA

EMTALA Emergency Medical Treatment and Active Labor Act (EMTALA) Part of the Consolidation Omnibus Budget Reconciliation Act (COBRA) Federal law -1986- addressed duty to treat Requires that hospitals receiving Medicare funding practice within the guidelines

#1- Presenting Patient Thou Shall: Document every patient presenting and their diagnosis Presenting patient defined as anyone entering any of the following: A dedicated ED or OB department Includes remote sites that see 1/3rd of patients on walk-in basis Upon campus within 250 yards of main buildings (ie. Parking lot, sidewalk, or hospital-owned buildings within 250 yards) Have name that suggests public should seek care (i.e. urgent care center) Note: Hospital property includes ambulances owned and operated by the hospital

#2- Medical Screening Thou Shall: Provide a medical screening to rule out emergency condition defined as condition that without attention would: Pose serious threat to the patient’s health Threaten impairment of bodily functions, or Threaten function of body organ(s) or part(s). (Emergency Nurses Association, 2000) Note: Provided by physician or physician extender (ie, CRNP, PA) Note: Triage not equivalent to medical screening exam

#3- Financial Information Thou shall not: Delay medical screening exam (MSE) to obtain payment information Induce patient to leave without MSE by drawing attention to payment issues or make financial demands of patient or family prior to MSE

#4- Testing within Capability Thou Shall: Provide testing within capability of hospital necessary to exclude emergency medical condition Not to be deferred to more convenient time or location Shall stabilize any abnormal findings

#5-Provide Stabilizing Care Thou Shall: Provide stabilizing care within capabilities of the hospital Patient is not likely to deteriorate from or during transfer or discharge OB patients with contractions are unstable until: Contractions stop or Baby and placenta are delivered

#6- Provide on-call Specialties Thou shall: Provide on-call schedules for medical specialties who agree to accept patients regardless of ability to pay Provide policies & procedures for cross-coverage Maintain these lists for 5 years

#7- Require Specialists to Respond Thou Shall: Without regard to ability to pay: Require on-call specialists to respond in timely manner Provide stabilizing care to presenting and transferring patients Enforce policies, procedures and actions against violators

#8- Transfer only the Necessary Thou Shall: Transfer only for services or care not available at facility or upon patient request- important component Accept transfers of patients for specialty services not available at facility where they originally presented Note: Transfer - Defined as movement of individual outside of hospital facility

#9- Screening Exam for Specific Conditions Thou Shall: Provide screening exam for specific conditions to first rule out general medical, toxic, or traumatic conditions in the following population: OB patients Patients with undiagnosed acute pain Symptoms of substance abuse Symptoms of psychiatric disturbances

#10- Receiving Hospital Acceptance Thou Shall: Obtain and document acceptance from receiving hospital

#11- Outline Transfer Risks Thou Shall: Complete written certificate indicating: Risks and benefits of transfer That benefits outweigh the risks

#12- Transfer with Support Thou Shall: Provide transfer to receiving hospital via: Qualified transport personnel Medically appropriate vehicles Adequate life support equipment Note: Private auto does not meet standard unless signed refusal by patient

#13- Provide Records with Patient Thou Shall: Send copies of the following with patient to receiving facility: Medical records Laboratory results Reports Consultation Records

#14-Physician Failure to Respond Thou Shall: Provide name of on-call physician whose refusal to respond resulted in patient transfer to another facility

#15- Consent to Transfer Thou Shall: Obtain written consent to transfer from: Patient Responsible party Provide documentation to justify failure to obtain written consent

16#- Written Refusal of Services Thou Shall: Obtain written refusal of services (exam, treatment, ambulance or transfer) by patient or responsible person Refusal must contain specific risks of refusal and advantages of consent

#17- Document, Document, Document Thou Shall: Document the following: History Physical exam Monitoring results Intervention results Note: Failure to document intake & discharge vitals are not mandated but have repeatedly resulted in citations regarding Medicare conditions of participation.

#18- Ongoing Reassessment Thou Shall: Reassess and document patient findings as condition or category warrants Note: Failure to reassess during extended waiting times and during course of treatment frequently results in citations

#19- Post EMTALA sign Thou Shall: Post sign that explains patient’s rights under the law in any area of hospital or remote site that qualifies as dedicated Emergency Department

#20- Report Violations Thou Shall: Report suspected or possible violation by another facility that resulted in improper receiving of patient immediately to your supervisor or manager Report refusal by another facility with special services to accept patient from your facility Note: Organization has an obligation under the law to report violations within 72 hours to authorities