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ER first encounter for patients

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Question for everyone...

Is it an EMTALA or joint comission requirement that the first person to see/speak to a patient entering the ED for treatment be a clinical associate? If so, do you know where I can get a copy of that regulation to review?

Thanks

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

What do you mean clinical associate? EMTALA

The essential provisions of the statute are as follows:

Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition". If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives.

What constitutes "coming to the emergency department"? See our
special note
on the 250 yard rule and its discussion of presentations to locations other than the emergency room, as well as the further discussion below.

If the patient does not have an "emergency medical condition", the statute imposes no further obligation on the hospital. A pregnant woman who presents in active labor must, for all practical purposes, be admitted and treated until delivery is completed, unless a transfer under the statute is appropriate. The statute explicitly provides that this must include delivery of the placenta.

In essence, then, the statute:

  • imposes an affirmative obligation on the part of the hospital to provide a medical screening examination to determine whether an "emergency medical condition" exists;

  • imposes restrictions on transfers of persons who exhibit an "emergency medical condition" or are in active labor, which restrictions may or may not be limited to transfers made for economic reasons;

  • imposes an affirmative duty to institute treatment if an "emergency medical condition" does exist.

Additional regulatory provisions

The regulation [42 CFR 489.24(a)] adds the following:

The person who does the examination must be specifically determined to be a "qualified medical person" by the hospital bylaws. The hospital must make the designation in its bylaws or rules and regulations.

FAQ on EMTALA

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

250 yard rule

At locations on the hospital campus and within the 250-yard sphere but not at a Dedicated Emergency Department, the obligation under EMTALA arises only if (1) a request for emergency services is made, or if (2) a reasonably prudent layperson would conclude, based on the person's appearance or behavior, that he is in need of emergency treatment. This will include new conditions which arise for visitors or employees.

For instance....

Our current set up requires that the patient check in with registration. They obtain the patients complaint and basic demographic info. However, we keep paramedics in our waiting room to monitor patients arriving for treatment and to monitor those still waiting for a bed. Is it permissible ever for registration to be alone when signing patients in....or does alone clinical associate, like alone medic or RN have to be present at the time the patient checks in?

I was just wondering if this is an actual regulation, or just best practice for emergency departments.

Sorry...should have also said...

The Paramedic is supposed to assist in obtaining the complaints from the patients as registration has no clinical training to make assessment decisions. Therefore we require registration to sign them in but then at some point the medic has to see the patient as well to see what the extent of the illness is.

tarotale

Has 1 years experience.

we have a first look nurse who is experienced RN. That shift is pretty cushy especially at night shift. mostly consists of sitting at front desk and screening to see true cp or stroke... and most of times the nurses hate to do first look lol

I work in 2 places right now.

In both, the first person the pt sees is a clerk/secretary type.

At the smaller hospital, registration is adjacent the clinical area, and a RN always speaks to the pt prior to waiting rm- make sure that shoulder pain after lifting isn't radiating to the jaw.

At the larger hospital, all they see is a registrar who then types the stated complaint on the tracker. The charge RN uses the WAG system to determine whether it can wait, or needs immediate rooming.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

You can review the EMTALA regs that Esme provided above. No, there is not a requirement that "first contact" be with a clinician, nor do I think that it necessarily should be - I think it's fine for a registrar to get the ambulatory patient in the system.. I do believe that there needs to be a clinical pair of eyes out there though, and I am happy to report that I have successfully waged that battle where I have worked.

emtb2rn, BSN, RN, EMT-B

Specializes in Emergency. Has 21 years experience.

Registration is the 1st person the pt talks to at my facility. That being said, the triage rn sits about 10' from registration so we get to eyeball the pts as they come in the lobby.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

What do you mean clinical associate? EMTALA

FAQ on EMTALA

If you read the information on the link it will answer your questions.

The regulation [42 CFR 489.24(a)] adds the following:

The person who does the examination must be specifically determined to be a "qualified medical person" by the hospital bylaws. The hospital must make the designation in its bylaws or rules and regulations. The regulation also provides that the person must "meet the requirements of 42 CFR 482.55", although that rule really has no substantive requirements.