Reader Question: It's best to not reserve capacity, refuse transfers
It’s best to not reserve capacity, refuse transfers
Question: Can we ever “reserve capacity” for special purposes and refuse transfers even though we technically have beds open? We’d like to save an intensive care unit (ICU) bed for any in-house emergencies, but that might mean refusing to accept a transfer due to “no capacity,” and that seems like we’re telling a white lie.
Answer: Your motivation is understandable, but reserving capacity for a hypothetical need is a sure way to run afoul of the Emergency Medical Treatment and Labor Act (EMTALA), cautions Maxine Harrington, JD, associate professor of law at Texas Wesleyan School of Law in Fort Worth. Harrington notes, however, that EMTALA does not always require a hospital to accept a transfer. Hospitals must accept the transfer when the patient needs specialized care that is available at that hospital but not found at the transferring hospital, such as neonatal intensive care or burn treatment.
So for the discussion of reserved capacity, consider a situation in which Hospital A is trying to transfer a patient to Hospital B because Hospital B has the type of specialized care needed by the patient. Then the question becomes “Does the second hospital have the capacity to accept that patient?”
“Capacity” can be difficult to define and is not as simple as the term might imply, Harrington says. When investigating a possible EMTALA investigation, the government will look beyond simply how many beds were empty and whether one of them could have been used for the patient in question. Your hospital’s history of bed use may play a role, she says, because the government can look at how you responded to requests in the past. Did you move patients around in the hospital, call in additional staff, or borrow equipment from elsewhere? If so, the investigators may want to know why didn’t do that in this case.
The government expects you to be truly unable to accommodate the patient before refusing the transfer, Harrington says. So having a bed empty and reserved for some possible need in-house would not meet that standard, she explains.
But there is an important caveat. If that bed is reserved for a particular patient, such as someone in surgery or post-op recovery, that bed is not available. So you can set aside a bed for an actual patient who will need it soon, but not for a hypothetical need, Harrington says.
“You also can prioritize beds, and there is nothing wrong with giving priority to patients in your own hospital if the priority is based on acuity,” she says. “If you have one bed open and you have a patient in surgery who will need it in half an hour, you can honestly tell the other hospital that you don’t have a bed available right now.”
Can we ever "reserve capacity" for special purposes and refuse transfers even though we technically have beds open? We'd like to save an intensive care unit bed for any in-house emergencies, but that might mean refusing to accept a transfer due to "no capacity," and that seems like we're telling a white lie.
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