COVID-19 and Medical Decision Making

[bravotwozero]

Thoughts for the group but I don't see much reason to get near them and am planning to call from outside the room through the door.

Auscultation in most cases is just theater for patient satisfaction and we can essentially get what we need with the history, a pulse ox and other vitals, visualization, and +/- CXR.

The only reason I see to go in the room is to intubate

Do you have ipads with facetime available? Trump just relaxed regulations on telemedicine, so you're allowed to telescreen them with an ipad and send them out without physically being there. If not, i'd bring that up with your medical director.

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[Tiger26]

You may not be satisfying EMTALA.
You will need to find substantial evidence that a patient complaint of "Shortness of Breath" does not merit auscultating the lungs.
Otherwise you will lose.

Somebody can correct me if I'm wrong, but I'm not aware that EMTALA says to need to auscultate lung sounds

 

[thegenius]

Somebody can correct me if I'm wrong, but I'm not aware that EMTALA says to need to auscultate lung sounds

I will correct you. When you have EMTALA people coming around your place investigating, they will care not what you say. They will say "someone who complains of shortness of breath gets a stethoscope to their lungs." period. You can't argue it. Well you can, but you will lose.

You see....I know this be the case because I violated EMTALA once on these very grounds!!!

 

[turkeyjerky]

I will correct you. When you have EMTALA people coming around your place investigating, they will care not what you say. They will say "someone who complains of shortness of breath gets a stethoscope to their lungs." period. You can't argue it. Well you can, but you will lose.

You see....I know this be the case because I violated EMTALA once on these very grounds!!!

No. It’s not an emtala violation. It’s just bad (mal) practice.

 

[Tiger26]

I will correct you. When you have EMTALA people coming around your place investigating, they will care not what you say. They will say "someone who complains of shortness of breath gets a stethoscope to their lungs." period. You can't argue it. Well you can, but you will lose.

You see....I know this be the case because I violated EMTALA once on these very grounds!!!

Helpful information but what about the following:

COVID Specific EMTALA
• The content of the MSE varies according to the individual’s presenting signs and symptoms. It can be as simple or as complex, as needed, to determine if an EMC exists.
• MSEs must be conducted by qualified personnel, which may include physicians, nurse practitioners, physician’s assistants, or RNs trained to perform MSEs and acting within the scope of their State Practice Act.

https://www.cms.gov/files/document/qso-20-15-hospitalcahemtala.pdf

I'm talking about an exam with something like the following: "45 year old well-appearing make who ambulates easily into the room, speaks full sentences easily without difficulty, saturation 98% on room air, no tachypnea or retractions, no cyanosis"

The patient who looks unwell is a different story of course, but what clinical benefit is there in auscultation in the worried well? In that case, I would say that it could be "as simple as needed" based on the CMS language.

 

[thegenius]

No. It’s not an emtala violation. It’s just bad (mal) practice.

Because an MSE is not well defined, if they (EMTALA Lawyers) define it as putting a stethoscope on someone's lungs if they complain of SOB, then you are going to lose. You can argue all they want that their RR is 14 and SpO2 is 99% and HR is 60.

I do not think you are going to win

 

[Brigade4Radiant]

Because an MSE is not well defined, if they (EMTALA Lawyers) define it as putting a stethoscope on someone's lungs if they complain of SOB, then you are going to lose. You can argue all they want that their RR is 14 and SpO2 is 99% and HR is 60.

I do not think you are going to win

What do you mean? Auscultate what? If you receive a note and a doctor went to the room you fulfilled and tell her it’s entirely vague I’m tell applies if you turn down someone. Also auscultation is the least of your worries will be more likely be sued for malpractice for not giving a person appropriate resources like a ventilator.

Or if y’all still tight then why did you give the patient nebs? Or a breathing treatment? Did you admit the patient or discharge the patient?

A lawyer can always find something but if the definition of the bag you can always make an argument against it. And honestly with all this going on even if you get sued by and tell her you could sue the hospital for OSHA violations for not having proper equipment for you.

 

[Painted]

Questions arise after teen's death was initially linked to coronavirus in California | CNN

California health officials are reevaluating the death of a 17-year-old boy from coronavirus, saying his case is "complex" and needs further investigation.

www.cnn.com

 

[turkeyjerky]

Because an MSE is not well defined, if they (EMTALA Lawyers) define it as putting a stethoscope on someone's lungs if they complain of SOB, then you are going to lose. You can argue all they want that their RR is 14 and SpO2 is 99% and HR is 60.

I do not think you are going to win

My position is that the EMTALA hype is driven by hospitals who want to place the burden onto us. Inappropriately discharging people home after an MSE is not an EMTALA violation.

What constitutes an adequate MSE is a fluid question. It can be argued both ways as well. You don't merely need to take a CMS lawyer's word for it.

 

[TooMuchResearch]

I can't hear anything with the disposable stethoscopes they've placed in the rooms, so the exam is mostly useless. Effin lawyers.

Because an MSE is not well defined, if they (EMTALA Lawyers) define it as putting a stethoscope on someone's lungs if they complain of SOB, then you are going to lose. You can argue all they want that their RR is 14 and SpO2 is 99% and HR is 60.

I do not think you are going to win

 

[bravotwozero]

I can't hear anything with the disposable stethoscopes they've placed in the rooms, so the exam is mostly useless. Effin lawyers.

So much this! Those yellow stethoscopes are a piece of crap. On top of that, I'm doing these in a negative pressure environment where the fan is blowing, and wearing a PAPR. Even if I use my regular stethoscope, I can't hear a damned thing.

 

[TooMuchResearch]

WHAT????
HUH????

So much this! Those yellow stethoscopes are a piece of crap. On top of that, I'm doing these in a negative pressure environment where the fan is blowing, and wearing a PAPR. Even if I use my regular stethoscope, I can't hear a damned thing.