Do you think the evaluation method is implementable in the short term and long term? Is the evaluation method sustainable and effective? Do you think it wo

Christine Discussion:

   The Emergency Medical Treatment and Labor Act (EMTALA) is a congressional act that was implemented in 1986. It is part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. EMTALA applies to Medicare-participating hospitals with emergency rooms and is intended to prevent hospital emergency rooms from transferring uninsured or Medicaid patients to other hospitals without examining the patient to determine if they are stable for transfer. The transferring of patients due to their financial status is typically referred to as “patient dumping” and EMTALA is intended to prevent this practice from occurring (American College of Emergency Physicians, 2024).

            The provisions of EMTALA ensure that any patient who arrives to an emergency department, regardless of their age, race, ability to pay, etc. is screened/examined for an emergent condition. For the purposes of EMTALA, emergent condition means the patient has experienced an onset of acute symptoms, the severity of which could result in serious harm to the patient, including death, if not treated immediately. If the physician deems that the patient has an emergent medical condition requiring treatment, the patient must be provided with treatment such that it stabilizes their condition prior to being transferred to an alternative hospital (American College of Emergency Physicians, 2024).

            Considering the above information, as well as the findings of the State Department of Health that Hospital A failed to provide a basic medical screening/examination to two older patients without insurance and with known cardiac histories (heart failure) prior to transferring them to Hospital B, I believe that Hospital A did in fact violate EMTALA. Therefore, it would be reasonable to implement a quality improvement initiative to try and reduce the risk of future EMTALA violations. The two initiatives that will be implemented to address this issue are to require education on EMTALA for all current and new employees at the hospital and conduct a peer review of the records for the providers in the two complaints.

            Initiative one, which relates to education, should be required for all current and new employees that work in departments affected by EMTALA regulations, such as the ED, urgent cares, labor and delivery, and mental health. Essentially, EMTALA applies to any department where patients may present emergently and without an appointment (Stanger, 2024). Typically, EMTALA does not apply to inpatient units where patients have been admitted for ongoing treatment so efforts should really be focused on other departments as above. The hospital should strive for a training completion rate of 100% for both new and current employees. This can be tracked/evaluated using sign in/attendance sheets for in person trainings or auditing the organization’s online training programs for EMTALA training completion. To evaluate the effectiveness of the training, hospitals can use mock EMTALA surveys to assess staff knowledge; use “undercover staff” in one of the above-mentioned settings to assess for compliant workflows that would reduce the risk of EMTALA violations; and regular chart audits to assess for potential gaps and risks which would indicate the need to re-educate staff (Pinamonti, 2024).

            Initiative two involves conducting a peer review of the records for the providers involved in the two complaints. The peer review should be conducted by other ED provider(s) with similar credentials as the providers under review. The purpose of the peer review is for a similarly qualified provider to review the case and assess for completeness and accuracy of the patient assessment; determine whether the treatment plan (i.e., medications, other interventions, referrals, etc.) was appropriate for the presenting problem; and to determine if there was any deviation from standard practice/regulatory requirements (Compliatric, 2020; Gonzalez, 2023). The efficacy of the peer review process for improving compliance with EMTALA regulations can be evaluated by using metrics such as assessing the providers for improvement in clinical performance (i.e., providing appropriate care for the identified presenting problem) as well as improvements in patient outcomes (i.e., a decrease in or no further transfers that could be construed as “patient dumping”) (Quality Peer Solutions, 2024).

References

American College of Emergency Physicians. (2024).  Understanding EMTALA.  https://www.acep.org/life-as-a-physician/ethics–legal/emtala/emtala-fact-sheet

Compliatric. (2020).  Peer review versus medical record review-what is the difference?

            https://compliatric.com/peer-review-versus-medical-record-review-what-is-the-

difference/

Gonzalez, K. (2023, November 20).  Everything you need to know about improving medical peer

review. MedPlace. https://blog.medplace.com/resources/everything-you-need-to-know-about-improving-medical-peer-review

Pinamonti, E. (2024).  How is EMTALA impacting emergency medicine’s bottom line? National

Association of Healthcare Access Management.

https://www.naham.org/page/ConnectionsHowIEMTALAImpacting

Quality Peer Solutions. (2024, August 21).  Best practices for conducting effective peer reviews.

https://qualitypeersolutions.com/best-practices-for-conducting-effective-physician-peer-reviews/

Stanger, K. (2024, February 13).  Avoiding EMTALA penalties. Holland & Hart.

https://www.hollandhart.com/avoiding-emtala-penalties

Jamal Discussion:

EMTALA was enacted by Congress in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act of 1985. In short, EMTALA was designed to prevent hospitals from transferring uninsured or Medicaid patients to public hospitals without, at the minimum, a medical screening examination to make sure they are safe for the transfer. The law requires Medicare-participating hospitals with emergency departments to screen and treat the emergency medical conditions of patients in a non-discriminatory manner regardless of race, ability to pay, insurance status, etc. (Stanman, 2023).

                EMTALA requires a hospital to perform a medical screening examination prior to transfer. The MSE is used to determine if an emergency medical condition exists. If the condition exists, then the hospital is required to treat and stabilize patient prior to the transfer. Finally, the transfer must be appropriately informed to the patient by informing them of their EMTALA obligations, risks of transfer and having the patient make a written request for the transfer (Stanman, 2023).

                Hospital A has violated EMTALA law by failing to conduct the Medical Screening Examination prior to the transfer. This is the first and most important step of EMTALA, as you risk transferring a patient without treating any emergency conditions that would have come from the MSE.

Initiative 1: Education

                Requiring education on EMTALA for new and current employees as well as requiring an annual training is a good initiative towards compliance. The Kirkpatrick Framework is often used to evaluate training progress. The Kirkpatrick framework uses 4 levels of learning: Experience, Learning, Behavior, and Results. This framework evaluates feedback on the experiences involved in the training, the type of teaching provided, and the learning that lead to improvement. These results lead to a change in culture and aim to minimize violations while improving satisfaction from patients (Parry et al., 2013). Initially, Qualitive data would be collected to indicate where the goal is being met or falling short. That information is used to update the current processes using improvement initiatives (Parry et al., 2013).  

                To maintain consistency, training currency should be tracked. EMTALA training should be broken down into an “initial training” and a “refresher” required annually. Technology may be needed to maintain an accurate, date-stamped training log that will alert when each employee is coming due.

Initiative 4: Patient Process

                This initiative suggests a patient is monitored as they undergo processes and provide on-the-spot training at any time during the process that non-compliance is detected. The best way to implement this initiative is with a tracer. A tracer allows evaluators to identify performance issues between processes. This allows for the analysis of organization providing care. This methodology is perfect as an individual tracer is usually used in high-risk areas ( Tracer Methodology Fact Sheet, n.d.).

 

References

Parry, G. J., Carson-Stevens, A., Luff, D. F., McPherson, M. E., & Goldmann, D. A. (2013). Recommendations for evaluation of health care improvement initiatives.  Academic Pediatrics,  13(6), S23–S30. https://doi.org/10.1016/j.acap.2013.04.007

Stanman, J. (2023). Overview of the Emergency Medical Treatment and Active Labor Act (EMTALA) and emergency abortion services. In  https://crsreports.congress.gov/product/pdf/IF/IF12355 (No. IF12355). Congressional Research Service. Retrieved November 21, 2024, from https://crsreports.congress.gov/product/pdf/IF/IF12355

Tracer Methodology Fact Sheet. (n.d.). The Joint Commission. https://www.jointcommission.org/resources/news-and-multimedia/fact-sheets/facts-about-tracer-methodology/