Transfer codes to ER not ICU

[MADDOG70]

Is it an EMTALA violation to send stroke "codes" to the ER from the hospital floor and to be evaluated, treated and then kept down there for long periods of time.... sometimes days cause there are no ICU beds available?

[JBudd, MSN]

I'm going to disagree with Flying Scot: the floors are not critical care areas, and really cannot keep a critical care pt there. If forced to, and it is rare, we have had crashing pts sent to the ER. They are considered boarded inpatients, not returning to an outpatient status. ER staff have critical care skills, and staffing should be adjusted to have that 1:1 or 1:2 ratio (in an ideal world). At least in my hospital, ED is better staffed than the floors.

Do we like it? no. Is it in the best interest of the pt? yes if it comes to floor bed vs. ED bed if no ICU available. Transfers would be to a different city, 75 miles away. Happens sometimes.

Once an ED pt is admitted, we consider them inpatients if we have admit orders and are waiting for bed assignments. When our smallish hospital is full, there have been >24 hour waits to get beds. We are responsible for the admit orders, total PITA, but what else is there to do?

[FlyingScot, RN]

Your hospital may consider them still admitted but I'm not sure the government does. Your ER must be different than the average ER in the US which are understaffed for the hordes of people they are trying to serve. I know in the ER where I worked I would have not only the ICU patient but at least three others. Plus I never said board the patient on a Med/surg unit. I said stabilize and transfer to a facility that has a bed even if it means moving them to a different city. That would be the best option for all. Well, accept for administration who wants to keep the money in house. Your code team should be able to manage them until the transport team arrives.

[Murse901, MSN, RN]

This is not an EMTALA violation. If you're uncomfortable with this happening in your department, you would be better served by bringing it to the attention of your supervisors rather than trying to literally make a federal case out of it.

[edlove]

EMTALA no longer applies once a patient is admitted even if their situation gets worse after admission. So it is not a EMTALA violation.

[tridil2000, MSN, RN]

Yes, this is a violation... EMTALA. Once a hospital stabilzes a pt, accepts them and admits them to a unit they have the obligation to provide care. Whether that pt needs an ICU bed all of a sudden is of no interest to the law. The law assumes hospitals can operate efficiently and care for their admitted pts. If the facility cannot accomodate the needs and or level of care of any pt and then sends them to ANY ED - that is considered dumping. The facility is SUPPOSED to call other facilities who CAN meet the pt's needs and transfer them there.

You CAN send them to the PACU to avoid ED "dumping" and an EMTALA violation.

[Murse901, MSN, RN]

Yes, this is a violation... EMTALA. Once a hospital stabilzes a pt, accepts them and admits them to a unit they have the obligation to provide care. Whether that pt needs an ICU bed all of a sudden is of no interest to the law. The law assumes hospitals can operate efficiently and care for their admitted pts. If the facility cannot accomodate the needs and or level of care of any pt and then sends them to ANY ED - that is considered dumping. The facility is SUPPOSED to call other facilities who CAN meet the pt's needs and transfer them there.

You CAN send them to the PACU to avoid ED "dumping" and an EMTALA violation.

Not an EMTALA violation. Sorry.

For your consideration: http://sharonavigadwp.com/kevin/hospital%E2%80%99s-duties-under-emtala-end-after-patient-is-admitted-to-hospital-for-inpatient-care/

A federal district court in Tennessee has held that a hospital has no duty under EMTALA to provide stabilizing treatment for an emergency medical condition that arises after a patient has been admitted to the hospital as an inpatient.

The Anderson court's ruling is consistent with an Indiana federal district court's recent decision in Haight v. Robertson, No. 3"03-CV-885 (N.D. Ind. Mar. 31, 2008), which held that EMTALA's duty of stabilization ended once a patient was admitted to a hospital for inpatient care.

[General E. Speaking, RN, RN]

This thread is like a tennis match- back and forth- yes and no. Just wondering if it is a violation...

[Murse901, MSN, RN]

This thread is like a tennis match- back and forth- yes and no. Just wondering if it is a violation...

The short answer is: no.

The long answer is: noooooooooooooooooooooooooooooooooo.