Avoid EMTALA violations: Use these strategies
If your nurses aren’t up to date on the Emergency Medical Treatment and Labor Act (EMTALA), you risk violations that can result in fines of up to $50,000 per violation, lawsuits for personal injury, and possible termination of the hospital’s Medicare provider agreement.
"It’s important to consistently inform and educate the frontline staff of the need for 100% compliance with EMTALA," says Rita Schlomer, RN, MS, APN, CEN, nurse manager for emergency services at OSF St. Joseph Medical Center in Bloomington, IN.
There are many clinical issues that fall under the EMTALA umbrella, says Laura Guerrieri, RN, BSN, director of emergency services at Gottlieb Memorial Hospital in W. Melrose Park, IL. "This makes it difficult for many ED nurses and even physicians to understand the EMTALA rules and regulations, so it is best to keep it simple," she says
Here are education strategies to consider:
• Use case studies. "This is a good technique for helping clinical staff understand actual documentation requirements," Schlomer says. "It helps them to retain information because it follows patient activity."
• Conduct monthly chart reviews. Guerrieri says that at her facility, chart audits are done monthly to ensure that all nursing documentation reflects compliance with EMTALA. Schlomer’s ED developed an audit tool that reviews all the content on the facility’s EMTALA transfer form for compliance. (See EMTALA Audit Tool.) "The form mirrors the EMTALA requirements and is basically a cue’ sheet for staff to ensure that the documentation is compliant," she says.
Schlomer obtains copies of charts and survey tools to check for any discrepancies. She identifies noncompliant staff and ensures that they receive additional education. For every transfer out of the facility, Schlomer reviews the reason for transfer and the EMTALA documentation done by nursing staff. "This offers an excellent opportunity for one-on-one education," she says.
• List EMTALA as a competency for nurses. ED nurses at Guerrieri’s facility are required to complete a competency in EMTALA compliance. Nurses are given a study packet that includes all the essential elements for EMTALA as it pertains to their everyday practice, she explains. The EMTALA study guide covers:
— the requirement that all patients presenting to the ED receive a medical screening examination, with no delay in providing the medical screening exam to inquire about the patient’s ability to pay;
- the guidelines for transferring patients;
- the importance of maintaining the ED log for every patient that presents to the ED;
- the requirement to accept patients brought by ambulance when the ED is on diversion;
- the obligation of on-call physicians to see patients in the ED;
- requirements for response to emergencies on the hospital campus;
- how to inform patients about EMTALA.
After nurses review the material, a short quiz is given to determine their understanding of the law, she says. (Click here to see the quiz.)
"But the real test comes when policy is reflected in their practice," Guerrieri says. "The nurses practice EMTALA everyday, until it’s like second nature to them."
Sources
For more information about education on the Emergency Medical Treatment and Labor Act, contact:
• Laura Guerrieri, RN, BSN, Director, Emergency Services, Gottlieb Memorial Hospital, 701 W. Melrose Park, IL 60160. Telephone: (708) 450-4988. Fax: (708) 681-1545. E-mail: [email protected].
• Rita Schlomer, RN, MS, APN, CEN, Nurse Manager, Emergency Services, OSF St. Joseph Medical Center, 2200 E. Washington St., Bloomington, IL 61701. Telephone: (309) 662-3311, ext 3018. Fax (309) 662-7226. E-mail: [email protected].
If your nurses arent up to date on the Emergency Medical Treatment and Active Labor Act (EMTALA), you risk violations that can result in fines of up to $50,000 per violation, lawsuits for personal injury, and possible termination of the hospitals Medicare provider agreement.
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