What can you legally tell patients about delays?

Avoid EMTALA violations: 6 tips

Are you ever tempted to tell a patient with a sore throat who comes to your ED on a busy Saturday night that he’ll most likely be there in the morning, still waiting to be seen? What about if a woman with a headache asks you if she’ll make it home in time to pick up the kids at school — and you take one look at the crowded waiting room and know the answer is "no"?

Getting specific about wait times can result in a violation of the Emergency Medical Treatment and Labor Act (EMTALA), warns Shelley Cohen, RN, CEN, educator for Hohenwald, TN-based Health Resources Unlimited, a consulting company specializing in nursing education.

Cohen recommends that you check all policies related to EMTALA with your risk manager and/or legal counsel.

"If it can be in any way construed, even if you did not intend so, that they left because you implied that they would have to wait awhile, you are a setup for an EMTALA citation," warns Cohen. "That is the bottom line."

However, a shrug or "I don’t know" response won’t do any wonders for your patient satisfaction scores. At Harris Methodist Hospital in Bedford, TX, a question on satisfaction surveys asks patients, "Did you get clear, complete explanations about delays?" says Linda Russell, RN, ED manager. "The scores showed the patients were not told why there are delays," Russell says. "This is an area that needs improvement, according to our satisfaction scores."

To keep patients informed without violating EMTALA, do the following:

• Use scripted replies.

Cohen recommends having scripted messages on hand to refer to. "You don’t have to recite them verbatim — you can and should impart your own personality," she says.

The important thing is that all ED nurses are consistent in the information conveyed to patients, explains Cohen. "You may use different words to describe it, but the message should be the same 24 hours a day, seven days a week," she says.

• Make it personal.

"Say something specific about why the patient came," advises Cohen. For example, you might tell a worried mother, "I understand it is difficult to wait when you have a sick child by your side."

If patients really press you for an answer about delays, find out why, advises Cohen. "Ask, Is there another problem we should know about?’" she says. "This is how you find out if there is a baby sitter issue or employer concern."

This information allows you to respond, "Any time you are concerned enough to come to the ED, we always recommend that you stay until your care is completed," says Cohen.

• Explain why you can’t predict wait times.

Cohen suggests telling patients, "As you know, because this is an ED, we never know who or what will come through our doors. You can imagine how difficult it is then, to predict how long anybody will have to wait."

• Tell patients what you can do for them while they are waiting.

When patients ask about delays, it’s a perfect time to explain standing orders or protocols for laboratory tests, medications, or X-rays, suggests Cohen. You can tell patients: "While you are waiting, we do have orders from the ED physician to give you medication for your child’s fever. I can give you that now," or "A technician will be coming to get you for an X-ray to help speed up the process, so when the doctor does see you, your X-ray already will have been taken."

• Consider EMTALA implications before posting wait time signs.

Some EDs actually post current wait times in their waiting room, but this is a potentially risky practice, says Cohen. "Some have color signals, such as When this color is red, the wait time is more than 30 minutes," she says.

It’s OK to have a policy to tell patients if the wait time exceeds a certain amount of time, says Cohen. "But if your patients can construe from that information that they may not want to hang around, then you have a problem," she says.

For instance, if you post a sign that says the waiting time is shorter than 60 minutes and you suddenly receive several trauma patients, the sign will be inaccurate and patients may complain, adds Cohen.

Still, some EDs have posted wait times for years and have never had a problem, acknowledges Cohen. "But if you are considering doing this, you’ve got to involve risk management and hospital legal counsel," she advises.

• Never say anything that could be construed as discouraging patients from waiting.

Avoid mentioning the possibility of the patient leaving unless they bring it up first, says Cohen. For instance, don’t tell patients, "If you need to leave, please let me know," unless the patient already has made it clear that he or she might be unable to wait, she explains. "If you tell a patient, "It’s going to be a long while before the doctor gets to you," that could be interpreted as encouraging them to leave," she stresses.

Sources

For more information about what to tell patients about delays, contact:

  • Shelley Cohen, RN, CEN, Consultant, Health Resources Unlimited, 522 Seiber Ridge Road, Hohenwald, TN 38462. Telephone: (888) 654-3363 or (931) 722-7206. Fax: (931) 722-7495. E-mail: educate@hru.net. Web: www.hru.net.
  • Linda Russell, RN, Emergency Department, Harris Methodist H-E-B, 1600 Hospital Parkway, Bedford, TX 76022. Telephone: (817) 685-4729. E-mail: LindaRussell@texashealth.org.