Few EMTALA violations involve vascular-related issues, according to the authors of a recent analysis.

“Our motivation for the study was to assess for EMTALA violations in our field, vascular surgery, in order to better understand how these happen,” says Jeffrey Siracuse, MD, MBA, one of the study’s authors and an attending surgeon in the division of vascular and endovascular surgery at Boston Medical Center.

Of 7,001 patients with an EMTALA violation from 2011 to 2018, only 1.4% were vascular-related. “An example would be not adequately stabilizing or fixing a vascular emergency, such as a symptomatic or ruptured aortic aneurysm, when the capability exists,” Siracuse explains.

Cases included cerebrovascular, ruptured aortic aneurisms, aortic dissections, vascular trauma, peripheral arterial disease, venous thromboembolism, dialysis access, and bowel ischemia. “Vascular surgical emergencies can sometimes be difficult to diagnose and recognize, even by diligent and well-meaning physicians and staff,” Siracuse notes.

These are the most common reasons for EMTALA violations, according to the analysis: Unavailability of specialists, inappropriate documentation, misdiagnosis, poor communication, inappropriate triage, failure to obtain diagnostic labs or imaging, and ancillary/nursing staff issues. The most frequent vascular-related violations specifically involved lack of vascular specialist availability. “This highlights an important issue. There are potential shortages of specialists, particularly outside of major cities,” Siracuse says.

Early diagnosis and triage is important in a vascular surgery emergency. “Developing specialist networks and having adequate call coverage can help improve patient access to emergency services,” Siracuse offers.