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Thu Jan 10 03:31:18 GMT 2008

In a message dated 08-Jan-08 20:20:48 Central Standard Time,  KMATTOX at aol.com 
writes:

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:  

Ben Taub is to be corporately congratulated on having enough of a spine to  
provide proper triage screening and referral of care.

While many smaller facilities are trying to emulate to some degree Ben  
Taub's success, the general run of community EDs do not have the depth of back  up 
that the larger, University or Charity based facilities do, particularly in  
available urgent care, much less specialty clinic, opening.

In the past two days, at least 20% of the patients I have seen between 9 am  
and 5 pm were referred to the ED by their personal physician because clinic  
overload and the perceived urgency of the situation. Approximately 20% of those 
 were urgent enough to require hospital admission. By the time I have 
finished my  triage evaluation, I have done around 80% of the evaluation (history and 
 physical) needed to render final care for that visit...and it doesn't make 
sense  to me to turn the patient away without care by that time.....however, 
the  smaller hospitals are figuring out that once that determination has been 
made,  it makes sense to have one of the business office folks talk to the 
patient and  lay out the rest of the options in terms of payment, including 
collecting  allowed co pays before final care is rendered in non urgent situations. 
Since  most of the co pays in our area are the equivalent of a couple of packs 
of  cigarettes, and many of our patients smoke, it is hoped that they will be 
able  to come up with the money...we shall see.

ck
Charles S. Krin, DO FAAFP

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