Access Management Advisor: Mind your EMTALA signage, expert cautions

Don’t overlook placement of important signs

A number of hospitals have been cited in the past few months for lack of signs notifying patients of their rights under the Emergency Medical Treatment and Labor Act (EMTALA), according to Stephen Frew, JD, a longtime specialist in EMTALA compliance.

All of the facilities cited had signs, although several had remodeled and forgotten to put them back up, says Frew, a web site publisher (www.medlaw.com) and risk management consultant for Physicians Insurance Co. of Wisconsin in Madison.

"The biggest problem was location," he explains. "All of these hospitals got cited for not having all of the proper locations covered, and they all got cited for not having signs in their ambulance entrances, among other locations," he points out.

Access managers with emergency department (ED) responsibility should take note of the following reminders regarding EMTALA signs, he suggests.

Signs, everywhere signs

Signs must be present in entrances that access the ED or obstetrics (OB) areas; in most hospitals, that amounts to all public entrances. As noted, signs particularly need to be posted in the ambulance entrance.

Signs must be in waiting areas where EMTALA patients regularly are seated, including overflow waiting areas. This means that areas such as one-patient waiting areas that are only used by the ED sometimes must still have signs. Other areas include urgent care, walk-in clinics, OB areas, and psychiatric intake areas.

Signs must also be in all treatment areas, which includes all treatment rooms and bays, and signs must be placed in registration areas used by walk-in patients. This includes cubicles used for privacy purposes.

The size of the sign matters. Regulations require that the signs must be clearly visible and readable at 20 feet. This typically means that signs with adequate fonts are in the range of 18 x 20 inches. Signs in small areas where the patient cannot be 20 feet from the sign can be smaller. Typical treatment room and cubicle signs are 8 x 10 inches.

EMTALA regulations indicate that the signs must comply with the Limited English Proficiency standards of the Department of Justice (DOJ) and the Office of Inspector General. Recent revisions to the DOJ standards set the threshold for signs in non-English languages at 1,000 patient contacts or 5%, whichever is lower. These are hospital contacts, not just the contact rate for the ED or a specific department.

Language for the signs, as specified by the Centers for Medicare & Medicaid Services, is available on Frew’s web site.