EMTALA, the federal Emergency Medical Treatment and Labor Act, governs virtually every aspect of hospital-based emergency services.1,2 Consequently, the medical and administrative directors of the emergency department (ED) will be charged with achieving ED compliance with EMTALA. Additionally, the hospital will look to the emergency physician ED director as the most knowledgeable medical staff member on EMTALA and expect them to assist the hospital, its legal counsel, compliance officer, risk manager, and medical staff leadership in ensuring that the hospital complies with the law.
Therefore, leadership of the ED must ensure that all of the EMTALA issues that relate to the hospital and the ED are adequately addressed in both policy and in practice. A compendium of the key issues, an “EMTALA Compliance Checklist,” is included later (see outline in Box 89-1). The best method to achieve compliance is to form a hospital “EMTALA Compliance Committee” (Box 89-2), which is charged with (a) ensuring that each item on the list is appropriately addressed, (b) regularly updating policies and procedures as needed, (c) reviewing EMTALA-related issues or concerns that arise within the hospital, and (d) educating hospital staff and the medical staff on their EMTALA duties and responsibilities. Quarterly or semi-annual meetings are usually sufficient.
Box 89-1 Outline of the EMTALA Compliance Checklist: Items to Address to Ensure Hospital and ED Compliance with EMTALA |Favorite Table|Download (.pdf)
Box 89-1 Outline of the EMTALA Compliance Checklist: Items to Address to Ensure Hospital and ED Compliance with EMTALA
Adopt (and enforce) a hospital-wide EMTALA policy as well as ED-specific policies.
Educate all appropriate hospital staff and medical staff.
Define the hospital's standard ED medical screening exam (MSE) process, including identifying “dedicated emergency departments” (DED) and designated “qualified medical personnel” (QMP) to perform the MSE, as defined by the government.
Establish the hospital's patient stabilization procedures and documentation.
Do not delay access to the MSE, stabilizing care, on-call physicians, or transfer on account of or to inquire about the patient's insurance status. (EMTALA's “no delay” provision.)
Address the ED/outpatient registration procedures and payment collection systems.
Implement processes and procedures regarding patient refusal of the MSE, stabilizing treatment, or transfer.
Implement an effective ED physician on-call system, with written duties and responsibilities.
Create a uniform system and “transfer packet” for transferring patients out of the hospital.
Create a system for accepting or rejecting patient transfers from other facilities.
Institute appropriate documentation requirements for ED medical records, a “central log” for patients presenting to the hospital, transfers, and on-call lists.
Post required “signs” in areas used for medical screening examinations, including the ED, labor and delivery (L&D), and psychiatric intake centers.
Monitor and quality assurance review the hospital's EMTALA compliance.
Draft a policy and procedure to report suspected EMTALA violations to CMS.
Review the potential application of EMTALA to the hospital's outlying facilities, such as urgent care centers (UCC), or ambulance/helicopter ...