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With the prospect of an H1N1 pandemic, "many stakeholders perceive that EMTALA [the Emergency Medical Treatment and Labor Act] imposes significant restrictions on hospitals' ability to provide adequate care when EDs experience extraordinary surges in demand," according to the Centers for Medicare & Medicaid Services. Recognizing that fact, CMS has issued a fact sheet to allay those fears.
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Getting chest pain patients with ST-elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI) within an average of 83 minutes is no small accomplishment.
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The electrocardiogram (ECG) and X-ray of a chest pain patient in his mid-50s were both normal when examined by the treating ED physician. However, the physician's shift ended before the patient's lab results were back. Based on the test results that were back, the oncoming ED physician discharged the patient as "chest pain, non-cardiac." Several hours later, the lab results came back with critical values.
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While The Joint Commission has not introduced any new National Patient Safety Goals (NPSGs) for 2010, that doesn't mean the clock has stopped on the implementation of earlier goals.
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Steady growth in Medicare dollars paid for outpatient observation services indicates that the introduction of "composite payments" in 2008 received the attention of hospitals. Medicare saw an increase of $73 million in payments for observation from 2007 to 2008.
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The ED at the University of Kansas Hospital in Kansas City has virtually eliminated ambulance diversion; there were two diversions in June. It also has reduced its rate of patients leaving without being treated from 12% to 4%. Both achievements are thanks to a targeted program developed by a team representing the entire department.
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"No unit is an island" might be the theme of a new Sentinel Event Alert from The Joint Commission (TJC).
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A lot can happen in 20 years, and certainly a lot has happened in the practice of emergency medicine both good and bad. But experts seem to agree that no single event has had more impact on the field than the passage of the Emergency Medical Treatment and Labor Act (EMTALA).
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Emergency medicine experts say the lagging economy is putting additional pressure on EDs that are already stretched to the limit, and that ED managers can look forward to even greater demand from patients while financial woes will lead to staff cuts, further exacerbating the situation.
