Emergency Services & Active Labor Patient Access to Emergency Services

Transcription

1 Emergency Services & Active Labor Patient Access to Emergency Services Page 1 of 5 Organizational Creation: 09/01/97 Update/*Review: 4/09/07, 9/2010*, 2/13/12, 03/21/2012 Owner(s): Christa Olsen, Compliance Auditor, Legal Services Policy Category: Impact, Patient Safety Program, Organizational Performance Improvement & Risk Management, Patient Safety Required Signature(s): *Add a R to review dates 02/13/20 15 Mariel Kagan, Master Administrator, Policy Coordinator,, Vice President, Chief Legal Officer & General Counsel PURPOSE For any individual arriving at Harrison Medical Center, for whom a request for care is made by either the individual or another individual on his or her behalf, or if a prudent layperson observer would believe, based upon the individual's appearance or behavior, that the individual needs examination or treatment for emergency medical condition, the hospital shall provide: A triage process to establish the order in which patients will be seen; An appropriate medical screening examination to determine whether or not an emergency medical condition exists or, in the case of a pregnant woman, whether or not she is in labor; and Necessary stabilizing treatment for emergency medical conditions and labor or; An appropriate transfer to another medical facility in the event that necessary treatment is not within the capability of the hospital. PROCEDURE Triage Any individual arriving at Harrison Medical Center requesting examination or treatment of a medical condition will be directed to the Emergency Department. Qualified personnel according to established triage protocols (See Emergency Department Triage Process Procedure and/or Triage of the Pregnant Patient in the Emergency Department - SpeedSearch) will promptly triage every individual entering the Harrison Medical Center Emergency Department requesting examination or treatment of a medical condition. (See Appendix for Triage Protocol for OB patients or SpeedSearch for departmental procedure.) Triage decisions shall not for any purpose be based on insurance status. After triage, patients will receive their medical screening examinations in the order determined by their triage priority status. This triage priority status may be adjusted in the event a patient s condition is determined to have changed from the time of the original triage evaluation. Medical Screening Examination Medical screening examinations are performed in a timely manner taking into consideration the need to gather identification information. Accurately identifying an individual seeking examination or treatment is crucial to the evaluation process by providing information about individuals and their medical history needed by the health care provider in his/her evaluation. Obtaining basic information such as name, address and other pertinent non-financial information necessary to open a medical record or to enter the individual into the hospital information system is permitted as it will facilitate access to information useful for the patient s care. Keywords:

2 Harrison Medical Center shall not delay a medical screening examination in order to inquire as to or verify the patient s method of payment or insurance status. However, if, during the identification process, payment or insurance information can be obtained without delaying examination or treatment, then such information may be gathered so long as it does not discourage the patient from remaining in the hospital to receive a medical screening examination or necessary stabilizing treatment. Every patient triaged to the Harrison Emergency Department shall receive a medical screening examination by a physician, a physician assistant (PA), or a sexual assault nurse examiner (SANE). Every patient triaged to the Labor and Delivery area shall receive a medical screening examination by a physician with obstetrical privileges or by a qualified labor room registered nurse in consultation with a physician. Qualified Nurse: A Registered Nurse with greater than two (2) years experience as a Labor and Delivery nurse at Harrison Medical Center; or demonstrated Competency for an Experienced Labor & Delivery nurse or equivalent hospital with BLS and NRP certification as well as training in fetal monitoring. Patients in the triage queue awaiting the completion of their medical screening examination shall not be referred outside the hospital to their physician, medical group, HMO or to any other off- campus facility. In the event the patient refuses to remain at Harrison Medical Center for the completion of the medical screening examination, Harrison Emergency Department nursing personnel shall: o Explain the importance of the medical screening examination and possible treatment; o Inform the patient or responsible individual of the risks and benefits associated with withdrawal versus examination and treatment; o Take reasonable steps to secure patient s (or legally responsible person acting on his or her behalf) written informed consent for refusal to complete evaluation and treatment; and (iv) document these steps in the medical record. If, following the completion of a medical screening examination, it is determined that the patient does not have an emergency medical condition, and authorization for treatment is denied by the primary care provider or insurance company, the patient will be given the opportunity to obtain treatment at Harrison Medical Center by signing a notice of noncoverage (such as an Advance Beneficiary Notice) for financial responsibility. Treatment of Emergency Medical Conditions If, following the completion of a medical screening examination, it is determined that an emergency medical condition exists, the patient shall receive appropriate stabilizing treatment within the capabilities of the staff and facilities available to the hospital. Harrison Medical Center shall treat patients with emergency medical conditions regardless of disability, race, sex, age, national origin, citizenship, preexisting medical condition, ethnicity, sexual orientation, religion, insurance status, economic status, or ability to pay. In the event the patient refuses to remain at Harrison Medical Center for the completion of the stabilizing treatment or to consent to treatment, Harrison Emergency Department medical staff shall: o Explain the importance of the stabilizing treatment; o Inform the patient or responsible individual of the risks and benefits associated with withdrawal versus examination and treatment; o Take reasonable steps to secure patients (or legally responsible person acting on his Emergency Services & Active Labor Patient Access to Emergency Services Page 2 of 5

3 or her behalf) written informed consent for refusal to complete evaluation and treatment; o And document these steps in the medical record. (See Against Medical Advice or Informed Consent to Leave the Hospital Procedure in SpeedSearch.) Discharge and Transfer When it has been determined that an individual has an Emergency Medical Condition and the hospital has exhausted all of its capabilities in attempting to stabilize the condition, the hospital shall effect an appropriate transfer of the individual according to transfer policy entitled Transfers of Patients to A nother Harrison Medical Center F acility and Transfers of Patients to Another Acute Care Facility. The Transfer Policies are located in Speed Search. This policy sets forth requirements for the general restriction of transfer until the individual is stabilized as set forth in 42 CFR (e), including physician certification requirements, or certification for transfer by another medical person as defined by hospital in its Bylaws, Rules and Regulations. No patient determined to have an emergency medical condition shall be discharged from Harrison Medical Center until he/she has been determined by the treating physician to be stable for discharge. On Call List Harrison Medical Center maintains an "on call" list of physicians who see patients with potential emergency medical conditions in the dedicated Emergency Department. Definitions Medical Screening Examination is the process required to reach, with reasonable clinical confidence, the point at which it can be determined whether an Emergency Medical Condition does or does not exist. Depending on the patient s presenting symptoms, the medical screening examination represents a spectrum ranging from a simple process involving only a brief history and physical examination to a complex process that also involves performing ancillary studies and procedures such as (but not limited to) lumbar punctures, clinical laboratory tests, CT scans, and/or other diagnostic tests and procedures. A medical screening examination is not an isolated event. It is an ongoing process and must reflect continued monitoring according to the patient s needs and must continue until he/she is stabilized or appropriately transferred. There should be evidence of this evaluation prior to discharge or transfer. Emergency Medical Condition means a medical condition, manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances, and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in: o Placing the health of the individual (or, with respect to a pregnant woman, the health of a woman or her unborn child) in serious jeopardy; o Serious impairment to any bodily functions; o Serious dysfunction of any bodily organ or part; or o With respect to a pregnant woman who is having contractions: o That there is inadequate time to effect a safe transfer to another hospital before delivery, or o That the transfer may pose a threat to the health or safety of the woman or the unborn child. Stabilizing Treatment, with respect to an Emergency Medical Condition, means such medical treatment of the condition necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from, or occur during, the transfer of the individual from a facility, or that the woman has delivered the child and the placenta. A patient will be deemed stabilized if the treating Emergency Services & Active Labor Patient Access to Emergency Services Page 3 of 5

4 physician attending the patient in the emergency department/hospital has determined, within reasonable clinical confidence, that the Emergency Medical Condition has been resolved. For patients whose Emergency Medical Condition has not been resolved, the determination of whether they are stable "medically" may occur in one of the following two circumstances: o For purposes of transferring a patient from one facility to a second facility - "stable for transfer" or o For purposes of discharging a patient other than for the purpose of transfer from one facility to another facility - "stable for discharge". Triage is the process of determining in which "order" patients will be seen based on the apparent urgency of their presenting complaints. It is not equivalent to a medical screening examination and does not determine the presence or absence of an emergency medical condition. If an individual arrives at a hospital and is not technically in the emergency department, but is on the premises (including the parking lot, sidewalk and driveway) of the hospital and requests emergency care (on another person so requests on his or her behalf), he or she is entitled to a medical screening examination. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent layperson observer would believe, based upon the individual's appearance or behavior, that the individual needs examination or treatment for an emergency medical condition. An individual in a non-hospital- owned ambulance which is on Harrison Medical Center property is considered to have come to the Harrison Emergency Department. A patient in an ambulance not on Harrison Medical Center property is not considered to have come to the Harrison Emergency Department just because the ambulance personnel have contacted Harrison Emergency Department personnel. Harrison Medical Center may deny access to such patients when it is on "diversionary" status because it does not have the staff or facilities to accept any additional emergency patients at that time. However, if the ambulance disregards Harrison Medical Center s instructions and brings the individual on to Harrison property, the individual has come to the hospital and must receive a medical screening examination. References Cited 1) Emergency Medical Treatment and Active Labor Act,, Final Rule 2003 Emergency Department Procedure: Emergency Department Triage Process; 42 CFR (e) Emergency Services & Active Labor Patient Access to Emergency Services Page 4 of 5

5 Appendix Diagram 1 - OB Patients - See Procedure: Triage of the Pregnant Patient in the Emergency Department Emergency Services & Active Labor Patient Access to Emergency Services Page 5 of 5