ANP 652 5
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Grand Canyon University *
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652
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Medicine
Date
Apr 3, 2024
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docx
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Uploaded by PresidentKouprey3370
Using the Emergency Medical Treatment and Labor Act (EMTALA) as a resource, provide one example of a safe and legal emergency department transfer/discharge and one example of a concerning and potentially illegal emergency department transfer. Explain, in detail, each of the two situations and the safety and legal implications of these health care transitions for both the patient and the facility or facilities involved.
Support your answer with a minimum of
two APRN peer-reviewed resources.
One example of a safe and legal emergency department transfer/discharge:
A teenager comes to the ED complaining of chest tightness, wheezing, and shortness of breath and has a history of asthma. The physician does the
medical screening examination
(
MSE) and determines it is an asthma attack and an emergency medical consult (EMC). He gives her medication and oxygen to stabilize her. He then discharges her home.
This is a safe discharge and not an EMTALA violation. The physician correctly conducted the MSE and administered stabilizing treatment. The physician is not required to cure the underlying condition of chronic asthma before he can release her. He must stabilize the attack. EMTALA is no longer applied once the patient has stabilized
.
Medical Screening Examination (MSE)
According to EMTALA, all patients, regardless of insurance status, nation of origin, race, religion, etc., are entitled to an MSE if they are on a "hospital campus" (within 250 yards of a hospital building). The purpose of the MSE is "to determine whether or
not an underlying emergency medical condition exists." (Maughan, 2021).
Stabilization
If the MSE reveals an emergent condition, EMTALA mandates that the hospital stabilize the patient, meaning you are reasonably sure they can be transferred or discharged without clinical deterioration. Of course, stabilizing a patient often requires other consultants, which means the EMTALA requirements and penalties also extend to them (Maughan, 2021).
One example of a concerning and potentially illegal emergency department transfer:
A woman suffers from a very high fever, nausea, and seizures. The on-call physician has determined that she should be transferred. To control her seizures, he gives her some medication and then immediately puts her in the ambulance.
The physician should have waited a reasonable time to see if the medication negatively affected the patient. He failed to provide stabilizing treatment within the capabilities of the facility prior to the transfer.
Transfers
EMTALA also requires that hospitals perform an "appropriate transfer" to a higher level of care if required by the patient's condition. To satisfy this aspect of the law, the
transferring hospital must fully treat and stabilize the patient of its resources, provide care en route, contact the receiving hospital (who has agreed to accept the patient), and transfer the patient with appropriate copies of medical records. (Transferring a patient without copies of the medical record, including imaging, is an EMTALA violation.) Correspondingly, the law mandates that the receiving hospital accept the patient if it has the appropriate resources to care for the patient (CMS, n.d.).
Penalties
EMTALA is tied to Medicare reimbursement, and severe violations can lead to the termination of the hospital or provider's Medicare Provider Agreement. Fines can reach $100,000 per violation, and hospitals may be liable for civil lawsuits from patients or from transferring or receiving hospitals ((CMS, n.d.).
References:
CMS. (n.d.). Know Your Rights (Emergency Medical Treatment and Labor Act (EMTALA). https://www.cms.gov/files/document/emtala-know-your-rights.pdf
Maughan, E. (2021). All about EMTALA: The law that runs the ED. EMRA. https://www.emra.org/emresident/article/emtala
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