Emergency Center Misuse Solutions

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Do NOT be intimidated by EMTALA.   EMTALA applies to IMMEDIATE  LIFE 
THREATENING EMERGENCIES.    EMTALA does NOT apply to  non-emergencies, or established 
conditions without a NEW and urgent emergency  condition.      
 
We have developed a program we call RIGHT CARE at the entry location to our  
hospital .  It is outside the sign age of the Emergency Center and before  the 
nurse triage desk of the emergency room.    A trained nurse  practioneer who 
is under the supervision of a physician screens each patients  complaint and 
performs an examination.   If the person has a very  liberal list of immediate 
life threatening or potential life threatening  conditions, they are 
immediately sent to the Nurse EC Triage Desk where  appropriate emergency center triage 
is performed.     Should  there not be a real emergency, then the patient is 
presented with a series of  decisions:  
 
1.    Your condition does not require that you be seen  and evaluated 
tonight.    We have a series of community based  clinics at which you can receive 
care at a discounted rate, depending on your  elgibility classification, provided 
you meet our hospital/clinic elgibility  requirements.     You will be given 
the next available  appointment
 
2.    If you are already a hospital/clinic eligible  patient and have a "gold 
card" stipulating your co payment status, we will make  the next available 
clinic appointment for you.     If you  have a gold card and really wish to be 
seen tonight by the "urgent care doctors"  at this Right Care Clinic location, 
you will pay an extra fee to be seen tonight  in keeping with our expenses to 
have such an off duty doctor and nurse  present.   These are the same doctors 
that work in our community  health clinic system.   
 
3.    If you do not have a current gold card, but  really mandate that you 
want to be seen tonight, you will be seen for your  non-life threatening 
perceived urgent clinical need, but you will need to pay  cash for that care tonight. 
 This payment is considerable more than a  potential discounted co payment 
rate, in that you have not yet established  elgibility.       If you really 
think that you  have an immediate life threatening emergency, a doctor will 
evaluate you for  that, and you will be sent to the emergency room.       We have 
already examined you and have determined in our best judgement that you  do not 
have an immediate emergency.    
 
For the last 18 months we have kept a very tight audit on the quality of  
this program and addressed its legality, its reduction in the emergency room  
load, the increasing percentage of patients who are admitted to the emergency  
room with a true immediate life threatening emergency, and the accuracy of the  
decisions and checks and balances made by the triage nurse  clinician.      
 
THIS SYSTEM WORKS.  There is NO reason that an emergency room should  be a 
place where a non-eligible or cleared person with a non-life threatening  
condition, but which can and should be worked up in a clinic (biliary colic,  breast 
mass, non obstructing hernia, etc).   A patient from another  country who 
arrives by bus with a suitcase and a CT scan made 2 weeks prior and  has a 
chronic clinic type condition requires an evaluation in an emergency room  if there 
is another mechanism to assure that this person is safe to send to the  
elgibility (and discounted co pay determination) location and be worked up in a  
clinic location.      To bring such a person into the  "EMERGENCY/Trauma Center" 
is a misuse of the emergency /trauma system and to  further admit such a 
patient as an EMERGENCY ADMISSION is a utilization  misuse.   
 
k
 
 
In a message dated 1/8/2008 5:42:30 P.M. Central Standard Time,  
c_brault at yahoo.com writes:

Laws  such as EMTALA, make sure that if you do not have insurance, you will 
still  receive care and I would suspect that if you live in AZ, CA, KY or any 
state  (places that have similar county or university hospitals), you get care 
on  demand without the demonstrated ability to pay. Certainly this means  
life-saving care. 





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