Suture Removal without Medical Screening?

[Chad Gardner]

Our ER is constantly increasing in patient visits, as are most ER's. Does anyone know if it is an EMTALA violation to remove sutures by a nurse without a medical screening by a "medical provider." A protocol would be in place for wound description and documentation of suture removal. Simply put does an emergency room patient with a chief complaint of suture removal have to see a MD, PA, or NP.

[ParalyticAgent]

I don't believe it's an EMTALA violation, but your physician group's legal people may take issue with it. All of our suture removals need a provider evaluation. It literally takes them 30 seconds to look and make sure there is no s/s of infection or poor healing.

[Britishkerry]

Our hospital screens suture removal to the clinic or their PCP unless there is any s/s of infection etc. it is not an emergency and therefore can be seen in the clinic.

[nurse2033, MSN, RN]

Our triage nurse will remove sutures. The patient is not charged as the removal fee is included in placing them. They create a patient chart and document what was done. If there is any reason to involve a provider that is done.

[Chad Gardner]

Nurse2033, we are basically there. Admin still wants us to have a PA give a quick blessing. I am curious how your admin views EMTALA on this matter.

From where I came, patients could have sutures removed by the RN without seeing a doc if (a) sutures were put in by our docs, (b) it's within the time frame recommended by the doc when the sutures were placed, © the patient had NO COMPLAINT... there is no chief complaint, only a request..., (d) the doc didn't order follow-up or re-evaluation on the original d/c instructions, and (e) the patient wasn't requesting to see the doc... this required, of course, that the patient was deemed competent at both the original d/c and upon their return.

It was not deemed an EMTALA violation because the patient had no complaint and wasn't requesting to see a physician. We never had a problem with it.

[turnforthenurse, MSN, NP]

Our triage nurse removes sutures/staples in triage. Patient chart is created to document and a provider will go out there just to do a brief check and then off they go.