EMTALA compliance checklist
___Create a written statement defining why you believe it will be advantageous to utilize nonphysicians for provision of medical screening exams.
___Create a cost analysis to determine cost-effectiveness of the proposal.
___Have risk management do a risk analysis to determine secondary costs/exposures. (Does the expected benefit justify the risks of administrative and civil liability and possible perceived reduction in standard of care?)
If the above still looks like the project is worth the effort, then define the way you intend to use the nonphysician screener in a draft policy
- For all presenting patients
- For non-urgent or specific triage categories only
(REMEMBER: Medical screening is not a glorified triage. It is essentially a completed ED visit, including necessary testing.)
- For certain types of presentations — What kinds?
Define individual’s authority in a draft policy
- Able to order tests? Which ones?
- Able to interpret tests? Which ones?
- Authority to discharge patients?
- Physician sees prior to discharge?
- Physician does NOT see prior to discharge (affects Medicare reimbursement)
Define limits of nonphysician role in draft policy.
- When MUST a physician conduct the MSE?
- When must a phone or verbal consult with MD occur?
- Are certain types of patients or degrees of triage NEVER appropriate for nonphysician MSE?
- May the nonphysician begin workup awaiting physician?
- What lab values trigger physician involvement?
- By known scope of practice limitations in the state
___Verify scope of acceptable practice with state licensure boards by having them review and give a letter of approval, if possible. If necessary, adjust to meet their requirement/limitations.
Prepare a list of necessary competencies in draft policy form.
- Training/credentials required
- Experience required
- Demonstrated competencies
- Necessary approvals from nursing and medicine leadership
___Define additional training, orientation, or certification to be completed upon approval and prior to assuming the role (in draft policy form).
___Assemble into a hospitalwide policy on nonphysician authority for medical screening.
___Prepare a draft departmental protocol that provides detailed instructions to those approved as screeners on how to handle the medical screening exam, forms to use, examples of situations, etc., in draft form.
___Create continuous quality improvement (CQI) indicators and criteria to monitor EMTALA compliance issues under the plan, compliance with protocols, and quality of care.
___Threshold of compliance for EMTALA is "zero error" tolerance. Policies should designate the individuals responsible for CQI monitoring, the frequency, the method by which it is handled for nonphysicians, the reporting chain, and the individuals responsible for discipline or enforcement.
___Create/assemble orientation materials and training program for designated screeners, and assign responsibility for implementation.
___Create a plan and assign responsibility for ongoing education for screeners.
___Submit the entire package to legal counsel experienced with the Health Care Financing Administration (HCFA) plans of correction in EMTALA citation situations for review and approval.
___[OPTIONAL] Submit the package to the regional HCFA office with a request that they review and comment on whether they find it acceptable as written.
___Implement plan AS WRITTEN. No deviations are safe.
___Watch VERY closely for situations that are not addressed by the plan, or that produce risky results not intended by the plan, so that immediate adjustments can be made.
Source: Stephen Frew, JD, Frew Consulting Group, Rockford, IL.
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