Medical Screening Exam at triage by RN

[RNinED]

Do you do the official EMTALA required MSE at your triage. We are getting ready to change from normal triage then MD medical screening exams to MSE done by the triage RN. That is, if our manager gets his way. I think there must be some formal training required but manager doesnt seem to think so. I know that we do a heck of a job at triage assessing med emergencies vs non-emerg. We already order many tests from triage to facilitate flow without the MSE having been done by MD yet. It still feels like we are taking on too much without further training to say now "triage is the MSE". The ENA seems not to recommend that triage be the MSE. your thought and experiences would be helpful.

[LLLLiiiFFEsaveer]

Medical Screening exams are outside of the RN scope of practice and only NP or PAs if the hospital Medical bylaws agree. You have to ask yourself what will be needed to completely medically screen a patient? Can you order a CAT scan on your license only? No so if someone comes in with the "worst headache" a medical screen would require a CT.. that should answer your MSE questions.. NO MSE by RNS . And EMTALA does not have within its scope the permission to perform MSE by an RN.. the State board does.. good to be knowledgeable of your state board and healthsystem policies as well as ENA ..

It obviously depends on where one works. The triage protocols are very extensive where I work. I have ordered several CAT scans on patients from triage. One example, would be the patient who had a headache located directly behind one eye (pain began 5 days ago). Their were a couple of other s/s too, but otherwise negative on the cincinatti stroke scale. Lobby wait times were crazy that night (even for ESI II's), and I just had that feeling for this patient, something was not right? Within 45 minutes of this patients registration time, I was reading the radiologists interpretated results of glioblastoma (sad). I am not sure by what you ment of ordering these scans on your license "only", but yes, we'll order practically any test we deem necessary from triage (even if that means placing an IV just prior to CT transport, etc...)

I am not too sure on the whole MSE being done by the triage RN though? That just seems like a bit to much for us to shoulder - having to triage, screen, order the appropriate tests, and discharge certain patients without them ever having been seen by an MD... That does not sit well with me.

[CraigB-RN, MSN, RN]

Ordering CT's is outside the realm of the MSE. The MSE is to establish whether an emergency condition exists. It's not part of Triage. IF the patient needs a CT then they are an ED patient and can't be turfed anywhere else.

And as others have posted, each state is different as well as each hospital.

WIth the current trend of MD or Midlevel in triage/RME/ whatever you want to call it, there is almost no need to RN's to be doing MSe's.

[rnmedic36]

I realize this is a dated string, however, I also know that it is still being read and used by those that have questions on this subject. That being said, there is clarification needed on several aspects.

Can RNs perform a medical screen per EMTALA?

Yes, they are allowed to perform an MSE as long as the respective BON allows and if the hospital involved has VERY SPECIFIC policies in place to designate those personnel allowed to medically screen and what competencies and specialized training they have for this activity.

What constitutes a Medical Screening Exam (MSE)?

EMTALA defines an MSE as an exam SEPARATE OF THE TRIAGE PROCESS which can use ANY RESOURCE NORMALLY AVAILABLE to the ED to determine if an Emergency medical Condition exists. They are very specific on both of these points and both have been proved multiple times under litigation.

I have no financial stake in the sites listed below, I think they may help some of you to find answers you are looking for on this and similar subjects. Have fun and always take the time to know the defining limits of your job!!

medlaw.com

emtala.com

hru.net

[VICEDRN, BSN, RN]

At my last job, we did Mse in triage. It was done by an rn. I agree that it is allowed by emtala and it is within the scope of practice of an rn in my state.

We used a drop down assessment tool that basically creates a pathway. The first question was like "is patient over 70 or less than 10?" next one, is patient ambulatory ( instructions included that patients in wheelchairs and stretchers were to be included in non ambulatory" even if they can walk. Any yes and the patient is screened in.

My experience is that you screen out dental complaints, people who want STD screenings without symptoms, people with no obvious signs of extremity injury and complain of mild or no pain to same, people who want refills of pain meds, lacs that don't require sutures, preg tests without symptoms, etc.

Any abnormal vital, even if it is tacky at 101, you keep the patient.

Yes, we had a separate class. Honestly, I fi d it sad if an er nurse thinks she can't screen out the above using a drop down assessment tool and even sadder if you think you need to hold an advance degree for same.

[RNMHSA]

RN's can do MSE's in CA under standardized procedures.