EMTALA: does the hospital representative accepting transfer need to be an attending physician?

[theWUbear]

My co-residents have differing opinions on a matter related to EMTALA and transfers. I've done some initial scouring of documents and am still unsure.

When an outside facility calls your tertiary center to transfer a patient, does the person on the receiving/accepting side of the call need to be an attending physician? I've heard this old tale that a nearby hospital was written up for an EMTALA violation for their nursing director insisting that they were OK to accept a transfer without putting a physician on the phone. My co-residents want to have the ability to pick up the phone and accept a transfer - especially if the department attendings are all in codes/traumas, and especially if it's low-hanging fruit like an auto-accepted patient for, say, trauma, with the trauma doc already having accepted the patient from the specialists' perspective.

I've been reading on EMTALA and I can't find anywhere that states that the receiving/accepting hospital must have the ED attending accept the patient. Can residents? Can midlevels? Can administrators?

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[Dr Mantis Toboggan]

The local quaternary care center often has midlevels take the call and accept the patient, but always on behalf of an attending.

ie “thank you, happy to take this transfer. Your accepting doc is Dr Jones”

My co-residents have differing opinions on a matter related to EMTALA and transfers. I've done some initial scouring of documents and am still unsure.

When an outside facility calls your tertiary center to transfer a patient, does the person on the receiving/accepting side of the call need to be an attending physician? I've heard this old tale that a nearby hospital was written up for an EMTALA violation for their nursing director insisting that they were OK to accept a transfer without putting a physician on the phone. My co-residents want to have the ability to pick up the phone and accept a transfer - especially if the department attendings are all in codes/traumas, and especially if it's low-hanging fruit like an auto-accepted patient for, say, trauma, with the trauma doc already having accepted the patient from the specialists' perspective.

I've been reading on EMTALA and I can't find anywhere that states that the receiving/accepting hospital must have the ED attending accept the patient. Can residents? Can midlevels? Can administrators?

 

[TooMuchResearch]

We took transfer calls our third year. Generally with an attending physician nearby, but I don't recall giving them the attending physician's name. One place I transfer to now routinely puts a PA or NP on the phone and doesn't give an attending physician name.

 

[GeneralVeers]

Depends on the hospital policy. My transfer center calls me and discusses the patient with me. If anything sounds fishy, I get on the line with the treating doc.

I try to avoid double transfers, so only punt when I don't think we have the right specialty on-call to take care of the patient.

We also don't accept transfers for "capacity". Oftentimes the sending doctor is trying to get rid of a boarded patient in their ED.

 

[deleted109597]

You'll never get an EMTALA violation for accepting a patient.
You could literally have a recording that just played "we accept this patient" over and over again and CMS would not bat an eye.

It's when you refuse patients that problems present. If you have a legitimate reason (capacity, lack of higher level of care), then perhaps you could get by with it, but generally hospitals will want a physician to be on the end of that stick.

My line is always "as the physician, I accept this patient. The hospital will determine if we have the capacity for the patient" so that it's on the recorded line that I don't refuse.

 

[deleted109597]

Also, the BS that is hospitals saying on ED doctors can accept to the ED is a crock. Anyone with privileges can accept a patient to the hospital, and if the upstairs is full or they're going to the OR, you better believe they can come to the ED. Making us have to talk to other people is a waste of ours and their time. If it's an autoaccept trauma, then don't bother the other people. Just notify them it's coming. I've never gleaned anything from listening to somebody trying to sell me a transfer. Just send it already.

 

[K31]

Our transfer center automatically accepts most transfers per protocol if we have the capacity to take them (ie beds in the hospital and upstairs). When we don’t have the capacity the ED attendings get looped in to accept or deny.

 

[docB]

You'll never get an EMTALA violation for accepting a patient.
You could literally have a recording that just played "we accept this patient" over and over again and CMS would not bat an eye.

It's when you refuse patients that problems present. If you have a legitimate reason (capacity, lack of higher level of care), then perhaps you could get by with it, but generally hospitals will want a physician to be on the end of that stick.

My line is always "as the physician, I accept this patient. The hospital will determine if we have the capacity for the patient" so that it's on the recorded line that I don't refuse.

Agree with all of this.

There is very little that is specified by EMTALA. Almost all of what we're doing is based on regulatory case precedent that has evolved over the years.

As I understand most current interpretations right now there isn't thought to be a requirement as to who or what (doctor, nurse, chef, water bottle) accepts a transfer, conducts an MSE or arrives out some of the other functions. It is required that the hospital have policies as to how these actions are carried out and that those policies be followed.

In my opinion I do not believe there is a requirement that an attending be the one to accept transfers.

 

[theWUbear]

This was very insightful, thank you