EMTALA violation for delay in MSE

[ERDude]

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Have you guys ever heard of a hospital being hit with an EMTALA violation for delay in MSE?

I've perused the info and cannot find any hard number as to a time in which the MSE must be completed. The reason I ask is I have heard of a case of a hospital being hit with a violation d/t MSE not being done in timely fashion. A friend had a case at his hospital (about a year ago) where a patient was triaged upon arrival (normal VS), put in room about 45 minutes later, seen by MD about 1 hour after that, had appropriate workup including labs/imaging/meds, and was discharged about 4 hours after presentation in stable condition (this info is second hand, so I'm not sure if it was single coverage and the doc was running a code, swamped, or why the 60 min from room-to-doc). No bad outcome that I'm aware of, but a complaint was filed with CMS and an investigation took place and the hospital was found in violation for delay in MSE.

Would be interested to know if anybody has heard of similar circumstances as this seems totally insane to me, and I can't find any guidelines as to what constitutes a "delay".

 

[keeping-it-real]

"Can you believe how they made me wait!!! And the nerve of them to not find anything wrong with me!!"

This case sounds bogus, though. Forget the single coverage community shops, let's talk about the county hospitals where people routinely wait 5-6 hours after triage, especially if they are there for very minor things. Same thing for some the Peds ERs where every other person is pulling the medicaid 5-fer.

If there was a time limit on the MSE, more than half of the ERs in the country and all of the county ERs would be violating EMTALA every single day.

 

[Birdstrike]

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[GeneralVeers]

"Can you believe how they made me wait!!! And the nerve of them to not find anything wrong with me!!"

This case sounds bogus, though. Forget the single coverage community shops, let's talk about the county hospitals where people routinely wait 5-6 hours after triage, especially if they are there for very minor things. Same thing for some the Peds ERs where every other person is pulling the medicaid 5-fer.

If there was a time limit on the MSE, more than half of the ERs in the country and all of the county ERs would be violating EMTALA every single day.

One could argue that if a nurse evaluated the patient and did vitals, that the patient had an MSE by a "medical professional" under the law. There is nothing that states a doctor has to see a patient to fulfill MSE requirements.

 

[Daiphon]

EMTALA violation? No... that requires an MSE (which was done) and timely stabilization of any identified emergent conditions... if you're sent back to the WR, then likely ESI 3, maybe 2. Both of which can wait for at least a little bit.

Now, people can and do complain to the state dept of public health, alleging an unsafe environment, which your description could fall under (but only if the investigator is a total tool)...

So, federal EMTALA was met, can't use it. State DPH regulations, that's a different matter.

Cheers!
-d

Sent from my DROID BIONIC using Tapatalk

 

[Birdstrike]

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[Birdstrike]

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[docB]

Interesting question. I agree with what others have said. EMTALA and CMS are different animals than we're used to thinking about. We tend to think in terms of avoiding bad outcomes. Here there was none but there is still hell to pay. This issue is similar to the patient who was treated appropriately but complains. That's another thing we have not been trained or accustomed to deal with.

The goal of EMTALA was to transfer the financial obligation to care for the uninsured to the hospitals. CMS wants that done and they want it done in a "timely manner." If your yardstick for "timely manner" is how long someone could have been harmed by an unrecognized emergent condition that time gets pretty short.

We leave people in the waiting room after triage for extended periods all the time because we're too busy. We rely on the triage nurse to identify the sick ones. This system fails occasionally so CMS is interested in forcing hospitals to spend more on it. Where we get rolled into this is that (as mentioned above) the CMS definition of what constitutes an MSE is whatever the hospital's policy says it is. Generally they don't say it's their employee's triage that fulfills the MSE. They say it's the EP's exam. So someone sitting in the waiting room with no emergency, triage level 5 has not had an MSE.

 

[ERDude]

I double checked with said colleague and realized I miswrote a bit.

This case reported to and investigated by the state health department (not CMS), who found the hospital to be in violation of EMTALA. CMS, as I understand it, was involved in determining the penalty/necessary "corrective actions".

 

[southerndoc]

We utilize an APP in triage during our peak times. It helps with both MSE's, expedites workups (as they frequently order x-rays and CT's), and helps LBS. Made the higher ups happy because they now no longer have missed revenue from LBS patients (which amounted to millions per year).