emtala question

Specialties Emergency

Published

Specializes in Emergency Room.

This is a little complicated, so bear with me!

I recently transferred (by BLS ambulance) a pt from our ER to a sister facility (the hospitals are owned by the same company). The pt. was transferred to the intake and assessment area of the behavioral health unit for evaluation to determine if he qualified to be admitted to the detox unit. This was not a Dr. to Dr. transfer. The pt. signed discharge paperwork from our ER, with the instructions that he go to detox. All of his paperwork, labs, etc. from our ER were faxed to the Intake and Assessment RN at the other facility. She then called and told our secretary that they would accept him. The secretary then called for transport and I was told the BLS ambulance would arrive in 15 minutes. I immediately called the other facility to give report to the RN (the ONLY RN there). I was told she was with a client, and they would have her call me back. Well...........the ambulance arrived before she called me back. I figured I'd send him, because I expected to be able to give report before he got there, and they were expecting him anyway. There really wasn't anything to give her report about, because supposedly that is why the entire chart was faxed to her in the first place. I just wanted to let her know I'd given one add'l dose of Ativan before he left. Long story short, on my third call to her, she was finally done with the client, and I gave her my brief little update. She then states she thinks that the patient is already there, and it was an emtala violation for me not to have given her report before he arrived. I don't think she will actually report me, she was sort of laughing, but you never know.

One of the other docs said, don't worry. The guy was actually DISCHARGED from the ER, and told to get to detox. We just arranged the transportation, and just fill out the Cobra forms on everything, even though this was not a doc to doc.

Any help? I'm just hoping she lets it slide, but think I can defend myself if she doesn't.

What a pain in the puttooty. If I hadn't had to call 3 times to give report, none of this would matter. Geuss next time, I'll just have to make the ambulance wait if they will).:sniff:

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Specializes in LTC, assisted living, med-surg, psych.

Did you document anywhere in the patient record that you called 3 times to try to give report? If you did, you're probably home free......you only have the responsibility to make the effort to give report, you can't force someone to come to the phone!

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If he was actually DC'd from your facility, then your call to the detox was essentially a "courteousy" call. No MD to MD transfer! End of story!!!

BUT, did you send TRANSFER papers? Different story.

(PS - did you get a consent to send a copy of his chart to the other facility?)

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Specializes in Emergency Room.

did document the phone calls. did sent copy of the cobra form (signed by the pt and doc) because that particular doc said, if in doubt, fill it out. Didn't get permission from the pt to fax the paperwork, and with all the ativan and etoh on board, probably not worth the effort. But he was by the time of transfer not particularily drunk anymore, very appreciative of my efforts and care, and am not worried at all about that aspect, since he also very much wanted to go.

I'm just thinking that since this was not in any way a doc to doc phone call, and since the patient signed our normal discharge paperwork, that I should be ok. hopefully..................keeping fingers crossed................:rolleyes:

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Specializes in Emergency Room.

OOPS, I picked new thread, instead of "post reply".............. can moderaters move this to my originial emtala post?

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Originally posted by erdiane

did document the phone calls. did sent copy of the cobra form (signed by the pt and doc) because that particular doc said, if in doubt, fill it out. Didn't get permission from the pt to fax the paperwork, and with all the ativan and etoh on board, probably not worth the effort. But he was by the time of transfer not particularily drunk anymore, very appreciative of my efforts and care, and am not worried at all about that aspect, since he also very much wanted to go.

I'm just thinking that since this was not in any way a doc to doc phone call, and since the patient signed our normal discharge paperwork, that I should be ok. hopefully..................keeping fingers crossed................:rolleyes:

Hey did I get the full story? sent Pt where? Not familiar with many things here just curious!

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Specializes in Emergency Room.

thks..........I'll try this again. I did document the calls to the RN. I did send the cobra form signed by the pt and the doc. I didn't get signed consent from the pt to fax his chart to the rn, but am not worried about that part. We've had discussions about these transfers in the past. One doc will not sign the cobra form, saying that this is a DISCHARGE from the er, with instructions to go to detox. He says he does not speak with the detox doc, therefore it is not a transfer. The doc I had (assigned to this pt. ) says, basically, always fill it out no matter what, can't hurt.

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it is not an emtala violation not to have given nurse to nurse report -

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if the pt was intoxicated - he can not actually be evaluated and discharged (he is in an altered state of mind and "cannot" give information) - so that is a problem -

otherwise - if he had d/c paperwork - who cares about transfer paperwork - that is null and void if you do not have an accepting physician at the next facility -

also - i am surprised an ambo came to get him - insurances won't pay for transfers unless it is a higher level of care (which this was not) - and otherwise the hospital eats the bill!!

the only worry i would have would be if a below legal limit breath or blood alcohol was documented prior to discharge - otherwise if anything happened to this guy - you all could be legally responsible.

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Emtala requires that a pt receive a medical screening exam and receive appropriate treatment to be stabilized and rule out any emergency situation. Since the pt was discharged by the MD, the report to the receiving facility was a courtesy. At our ED, we will often DC a pt and send to a behaivioral health facility while calling report to the facility as a courtesy. If the pt is a 1009 (voluntary commital) or a hold (1013/2013) they must be a transfer according to our facility.

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Originally posted by erdiane

OOPS, I picked new thread, instead of "post reply".............. can moderaters move this to my originial emtala post?

Done :)

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Kevro1013's right EMTALA has nothing to do with giving nurse to nurse report it's basically about turfing patients and refusing to see others.

First, I think technically if you really wanted to get right down to it he had been discharged from your facility. Secondly, he really had not yet been admitted to their facility; therefore, it seems to me it would be a violation of his right to privacy to discuss his case - trump.

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