EMTALA Q&A
[Editor’s note: This column is part of an ongoing series that will address reader questions about the Emergency Medical Treatment and Labor Act (EMTALA). If you have a question you’d like answered, contact Staci Kusterbeck, Editor, ED Management, 280 Nassau Road, Huntington, NY 11743. Telephone: (631) 425-9760. Fax: (631) 271-1603. E-mail: [email protected].]
Question: Is it a violation to fail to recheck vitals prior to dismissal or transfer (since without repeat vitals it cannot be determined if the patient has been stabilized)?
Answer: There is no specific EMTALA requirement for vital signs to be taken prior to transfer or discharge, according to Jonathan D. Lawrence, MD, JD, FACEP, an ED physician and medical staff risk management liaison at St. Mary Medical Center in Long Beach, CA. "As the reader correctly points out, it may not be possible to attest to the patient’s stability for transfer or discharge unless vital signs are taken," he says. "But I wouldn’t go so far as to say it is impossible to determine stability without repeat vital signs."
He gives the following example: A patient with an isolated finger flexor tendon laceration being transferred for hand surgery who looks well, is in no pain, has no active bleeding, and is awake, alert, and in no apparent distress can be deemed to be stable without a repeat set of vital signs. As a practical matter, though, it’s easier to have a blanket policy of repeating vital signs prior to transfer or discharge rather than leaving it up to judgment," Lawrence says.
Question: Our freestanding ED is affiliated with a major university hospital located 12 miles away, and we are staffed by the same physicians. At this time, our freestanding facility is unable to provide vascular studies and helical computed tomography scans. When our patients require one of these exams, they need to be sent down to the main facility. What do you suggest as an appropriate protocol for this scenario? Should the patients be transferred by ambulance, private auto if stable, or transferred to the main ED to continue their care?
Answer: Lawrence says he is not comfortable with protocols allowing for EMTALA transfers by private automobile. "That is not to say it is never appropriate, but the only way I can be sure a patient gets to where [he or she] needs to go is by ambulance," he says.
He notes that EMTALA requires the transfer to take place with appropriately trained personnel. "To me, that means emergency medical technicians at a minimum," he says.
Lawrence explains that even if there is virtually no likelihood that a life- or limb-threatening event would occur during transport, delays can occur. "The private automobile driver will get lost, decide that a lunch stop is more important, run out of gas, have a breakdown, or otherwise not arrive at the desired destination within an appropriate length of time," he says.
He points to the example given of helical computed tomography scans. "I have a hard time imagining a scenario where one of these studies is needed on a stat basis and the patient is perfectly stable without any reasonable likelihood of deterioration, which is the EMTALA definition of stability," he says. "I see no reason why the policy shouldn’t be to send these patients by ambulance only."
Source
For more information about EMTALA, contact: Jonathan D. Lawrence, MD, JD, FACEP, Emergency Department, St. Mary Medical Center, 1050 Linden Ave., Long Beach, CA 30813. Telephone: (562) 491-9090. E-mail: [email protected].
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