Be sure your EMTALA education is up to par
Knowledge of the requirements of the Emergency Medical Treatment and Labor Act (EMTALA) is lacking in the emergency department, according to a recent study.1
Researchers surveyed 123 ED physicians on 12 questions about EMTALA requirements, including medical screening exams, stabilization, and transfers. No respondent gave all correct answers, and 13% answered all incorrectly, with a median score of 42%. Only 20% said they had ever received any EMTALA education.
"I think we would find similar findings in emergency nurses," says Genie E. Roosevelt, MD, MPH, one of the study's researchers and fellowship director of the Section of Emergency Medicine at the University of Colorado at Denver and Health Sciences Center. "I think nurses would have the same knowledge deficiencies."
Ignorance of EMTALA provisions has become more perilous since Congress amended EMTALA in 1990 to allow enforcement actions even when physicians and hospitals are unaware of their own violations, she says.
Violations of EMTALA can result in penalties of up to $50,000 per violation, and may result in termination of the hospital's Medicare agreements. "The federal government may find a number of violations in a single patient encounter, so the actual fine from a single patient visit may accumulate up to several hundred thousand dollars," says Roosevelt.
In addition, patients who suffer harm may recover personal injury damages in a civil lawsuit against the hospital. "ED nurses need to understand the requirement for the medical screening exam," she says. "In addition, they need to know all pertinent issues regarding stability and transfer of patients, especially since they are often responsible for the organization of the transfer."
At a minimum, ED nurses should attend a lecture or seminar explaining EMTALA and its implications, says Roosevelt. "We found in our study that those physicians who had prior EMTALA training did significantly better on the questionnaire," she says.
At University of Colorado Hospital in Denver, EMTALA training is required for all ED nurses, says Lorna K. Prutzman, RN MSN, director of emergency services. "If a nurse violates EMTALA requirements after education, they receive disciplinary action. Additional education is done as needed based upon compliance issues."
Training focuses on typical events occurring in the ED that require EMTALA paper work to be completed, she says. "A specific patient population requiring transfer is the psychiatric patient. This is a high-risk group; therefore one of the scenarios would include this group," Prutzman says. "Another may be a patient requesting transfer because of insurance reasons."
At Escondido, CA-based Palomar Pomerado Health, ED nurses receive mandatory EMTALA education, given by the ED director or manager, twice a year. They have a series of computerized graphic slides that they update when the law changes, says Kim Colonnelli, RN, BSN, MA, service line administrator for emergency, trauma, and forensic services.
For example, previously EMTALA required hospitals to have an obligation toward a patient who had begun to receive services as part of a scheduled outpatient encounter and then subsequently experiences what could be an emergency medical condition. "The law has changed to say that the hospital does not have an EMTALA obligation toward this patient," says Colonnelli. "Their primary physician can be contacted or the medical doctor on duty, if that is the case." In other words, if the patient presents with what could be an emergency medical condition, a medical screening examination is required, she explains. "However, if they come for an X-ray and have their arm in a sling and have already seen their physician and they just need to know where to go, the staff is allowed to direct them to the appropriate place," Colonnelli says.
Another change involved patients who arrive in the ED for "nonemergency services." "If from the nature of their request, it is clear that they are not making a request for examination or treatment for a possible emergency medical condition, the hospital is not obligated to conduct a comprehensive medical screening exam," she says.
Even with training, ED nurses may have mistaken beliefs about the law's requirements, says Colonnelli. "A common misconception, which blows me away after all these years, is that if the patient says to the nurse 'Do you think I should just go to my own doctor?' the nurse will say yes," she says. "That is an EMTALA violation. Once the patient is here, we are obligated to conduct a medical screening exam."
Reference
- McDonnell WM, Roosevelt GE, Bothner JP. Deficits in EMTALA knowledge among pediatric physicians. Pediatr Emerg Care2006; 22:555-561.
Sources
For more information about education on the Emergency Medical Treatment and Labor Act, contact:
- Kim Colonnelli, RN, BSN, MA, Service Line Administrator, Emergency, Trauma, and Forensic Services, Palomar Pomerado Health, 555 E. Valley Parkway, Escondido, CA 92025. Telephone: (760) 739-3320. Fax: (760) 739-3121. E-mail: [email protected].
- Lorna K. Prutzman, RN MSN, Director of Emergency Services, University of Colorado Hospital, 4200 E. Ninth Ave., Denver, CO 80262. Telephone: (303) 372-8696. E-mail: [email protected].
- Genie E. Roosevelt, MD, MPH, The Children's Hospital, 1056 E. 19th Ave., Denver, CO 80218. Telephone: (303) 764-8695. Fax: (303) 764-8694. E-mail: Roosevelt. [email protected].
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