KAREN: EMTALA question!!!

[shay]

Another poster posted this in the OB nursing section:

"At my hosital, all of our OB patients present to the ER, where they are assessed and then sent to us if further monitoring is required. Once we receive them, they are again assessed (fetal monitoring and another admission assessment) and the doctor is notified of the results. However, if they are determined to be in false labor by the nurse, they cannot be discharged home until the physician sees them. Thus, they sometimes stay overnight just for braxton hicks contractions (which sucks for the patient!). In other hospitals where I've worked, we were able to discharge them with the doctor's phone order (for false labor). My hospital states that every other hospital is wrong and that it is an EMTALA issue. How do you guys do it at your hospital? I'd like to get feedback on my scope of practice as an L&D nurse and other hospitals' policies and procedures. "

Is it a violation of EMTALA to d/c a pt. without a doc seeing them?

[NRSKarenRN, BSN, RN]

4. What are the provisions of EMTALA?

http://www.uplaw.net/faq.htm

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. The regulation also provides that the person must "meet the requirements of 42 CFR 482.55", although that rule really has no substantive requirements.

Another section [42 CFR 489.20(q)(1)] requires that the hospital post a conspicuous sign which notifies patients and visitors of the right to be examined and to receive treatment. The sign must be in a form approved by the Secretary of Health and Human Services.

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42 CFR 482.55 Condition of participation: Emergency services.

http://www.scha.org/Public/PhyMdcreInfo/Medcare/CoP_for_hosp.pdf

The hospital must meet the emergency needs of patients in accordance with acceptable standards of practice.

(a) Standard: Organization and direction. If emergency services are provided at the hospital-

(1) The services must be organized under the direction of a qualified member of the medical staff;

(2) The services must be integrated with other departments of the hospital;

(3) The policies and procedures governing medical care provided in the emergency service or department are established by

and are a continuing responsibility of the medical staff.

(b) Standard: Personnel. (1) The emergency services must be supervised by a qualified member of the medical staff.

(2) There must be adequate medical and nursing personnel qualified in emergency care to meet the written emergency

procedures and needs anticipated by the facility.

The point here is that :

1. Emergency services must be SUPERVISED by medical staff.

2. Adequate Medical qualified must be available to meet written emergency procedures.

If your facility states that Medical staff must perform physical exam on patients presenting in ER prior to discharge then the hospital would be deemed negligent for only relying on Nursing assessment and NOT having physician physically examine the patient prior to Discharge. All depends on ER policies... CHECK THEM OUT!!! Karen

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EMTALA Action Points

9. Treat OB patients with contractions as unstable patients under the law.

http://www.tsged.com/cobraematala/EMTALA_Action_Points.htm

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THE "20 Commandments" OF COBRA/EMTALA

http://www.medlaw.com/20com.htm

Hope this helps!!! Also Posted in OB.