Here are some practices in emergency department (ED) registration areas that Gina Greenwood, JD, an attorney at Atlanta-based Baker Donelson, has seen come up in alleged violations of the Emergency Medical Treatment and Labor Act (EMTALA):
• Inadequate EMTALA signs.
“There has been a resurgence of surveyor focus on inadequate EMTALA signage,” reports Greenwood.
Hospitals are required to post an easy-to-understand sign specifying patients’ EMTALA rights in a very visible location at any ED entrance, admitting area, waiting room, and treatment area. “As the years pass and/or as EDs are renovated, hospitals sometimes forget to replace the EMTALA mandatory signage,” says Greenwood.
• Technical central log violations.
“These are also fairly common,” says Greenwood.
Hospitals are required to maintain a central log on each individual who comes to the ED or presents on hospital property seeking emergency treatment.
“The central log must detail whether the individual refused treatment, was given or was refused treatment, was transferred without stabilization, was admitted and treated, was stabilized and transferred, or was discharged,” says Greenwood.
• Registration staff failing to obtain appropriate documentation of patients who leave against medical advice or leave without being seen.
If an individual leaves the ED of his or her own free will, which means there was no coercion or suggestion by staff that the patient leave, and this action is appropriately documented, then the hospital is not in violation of EMTALA, says Greenwood.
“Refusal to consent to treatment generally is a competent, adult patient’s right and is also a full defense to EMTALA,” says Greenwood, if the hospital documents the following items:
- that it offered the person an exam and treatment;
- that it told the person about the risks and benefits of the exam and treatment;
- that it told the person about the risks of leaving;
- that the person voluntarily refused to consent.
“Commonly, patients will get tired of waiting and leave the hospital without telling registration staff,” says Greenwood. In this case, staff members should document in the medical record that they attempted to locate the patient.
MONITOR WAITING ROOMS
To avoid the situation of not being able to find a patient, registration staff should carefully monitor waiting rooms, and clinical staff should reassess patients every 15 to 30 minutes to avoid patients leaving without being seen, Greenwood says.
“Communicate periodically with patients regarding changes in their condition and where they are in line to be seen, without steering patients away,” she recommends.