DrGasPasser
Full Member
- Joined
- Feb 9, 2019
- Messages
- 264
- Reaction score
- 231
Your experience in FM provides a different contextual framework than what we experience as EPs. First, we are not discussing patients in the waiting room; sign out refers to bedded patient seen by a provider and where care is being transitioned to another provider.
Patient’s sitting in waiting rooms are an entirely different beast. While I’d agree that the risk is less than for bedded patients, it’s still there. This is especially true for a provider who shuts down triage an hour early while a patient is on the hospital property (be sure to familiarize yourself with EMTALA’s definition of hospital property). A quick Google Search of “EMTALA” and “waiting roomswill yield plenty of instances where institutions ran afoul of their obligations when it came to the timely initiation of medical screening exams and waiting rooms. That provider had better make damn sure their are no unregistered patients in the parking lot, bathrooms, etc. Those CMS investigators are unlikely to look favorably on a physician who didn’t begin screening and stabilizing those patients for that 1hr they were supposed to be working.
To the point made by @GeneralVeers , there are occasional times when EPs will turnover departments at the end of shift with empty beds. I’d agree that such instances are far less risky than an EP leaving the ED uncovered with patients sitting in beds. However, such “high five” sign outs (empty department and waiting room) are uncommon even at smaller shops thanks to psych boarding.
Finally, there is nothing magical about signing onto patients in the EMR. I only mentioned it because plaintiff attorneys will sometimes cast a wide net and start their lawsuits by naming every EP who signed on to a patient as a care provider. They typically narrow the list of defendants as per their discovery. I was personally named (and quickly dropped) in a case where I had planned to see a patient and signed on in Epic, but a partner took it.
Patient’s sitting in waiting rooms are an entirely different beast. While I’d agree that the risk is less than for bedded patients, it’s still there. This is especially true for a provider who shuts down triage an hour early while a patient is on the hospital property (be sure to familiarize yourself with EMTALA’s definition of hospital property). A quick Google Search of “EMTALA” and “waiting roomswill yield plenty of instances where institutions ran afoul of their obligations when it came to the timely initiation of medical screening exams and waiting rooms. That provider had better make damn sure their are no unregistered patients in the parking lot, bathrooms, etc. Those CMS investigators are unlikely to look favorably on a physician who didn’t begin screening and stabilizing those patients for that 1hr they were supposed to be working.
To the point made by @GeneralVeers , there are occasional times when EPs will turnover departments at the end of shift with empty beds. I’d agree that such instances are far less risky than an EP leaving the ED uncovered with patients sitting in beds. However, such “high five” sign outs (empty department and waiting room) are uncommon even at smaller shops thanks to psych boarding.
Finally, there is nothing magical about signing onto patients in the EMR. I only mentioned it because plaintiff attorneys will sometimes cast a wide net and start their lawsuits by naming every EP who signed on to a patient as a care provider. They typically narrow the list of defendants as per their discovery. I was personally named (and quickly dropped) in a case where I had planned to see a patient and signed on in Epic, but a partner took it.
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