1. Emergency Department EMTALA Education
Directions for Completion
1. Before proceeding to the posttest, be sure you have reviewed the PowerPoint program (best viewed as Slide Show).
2. Exit and complete the posttest which is final step of this education. “Take Test” may be a posttest or acknowledgment statement.
Remember, no attendance record is needed.
Completion of the posttest will be sent electronically to your EduTracker record once a 100% is
achieved.
3. Print the Certificate of Completion for your records if desired.

2. 20 Commandments of COBRA/EMTALA

3. EMTALA Emergency Medical Treatment and Active Labor Act (EMTALA)
Part of the Consolidation Omnibus Budget Reconciliation Act (COBRA) Federal law addressed duty to treat
Requires that hospitals receiving Medicare funding practice within the guidelines

4. #1- Presenting Patient Thou Shall:
Document every patient presenting and their diagnosis
Presenting patient defined as anyone entering any of the following:
A dedicated ED or OB department
Includes remote sites that see 1/3rd of patients on walk-in basis
Upon campus within 250 yards of main buildings (ie. Parking lot, sidewalk, or hospital-owned buildings within 250 yards)
Have name that suggests public should seek care (i.e. urgent care center)
Note: Hospital property includes ambulances owned and operated by the hospital

5. #2- Medical Screening Thou Shall:
Provide a medical screening to rule out emergency condition defined as condition that without attention would:
Pose serious threat to the patient’s health
Threaten impairment of bodily functions, or
Threaten function of body organ(s) or part(s).
(Emergency Nurses Association, 2000)
Note: Provided by physician or physician extender (ie, CRNP, PA)
Note: Triage not equivalent to medical screening exam

6. #3- Financial Information
Thou shall not:
Delay medical screening exam (MSE) to obtain payment information
Induce patient to leave without MSE by drawing attention to payment issues or make financial demands of patient or family prior to MSE

7. #4- Testing within Capability
Thou Shall:
Provide testing within capability of hospital necessary to exclude emergency medical condition
Not to be deferred to more convenient time or location
Shall stabilize any abnormal findings

8. #5-Provide Stabilizing Care
Thou Shall:
Provide stabilizing care within capabilities of the hospital
Patient is not likely to deteriorate from or during transfer or discharge
OB patients with contractions are unstable until:
Contractions stop or
Baby and placenta are delivered

9. #6- Provide on-call Specialties
Thou shall:
Provide on-call schedules for medical specialties who agree to accept patients regardless of ability to pay
Provide policies & procedures for cross-coverage
Maintain these lists for 5 years

10. #7- Require Specialists to Respond
Thou Shall:
Without regard to ability to pay:
Require on-call specialists to respond in timely manner
Provide stabilizing care to presenting and transferring patients
Enforce policies, procedures and actions against violators

11. #8- Transfer only the Necessary
Thou Shall:
Transfer only for services or care not available at facility or upon patient request- important component
Accept transfers of patients for specialty services not available at facility where they originally presented
Note: Transfer - Defined as movement of individual outside of hospital facility

12. #9- Screening Exam for Specific Conditions
Thou Shall:
Provide screening exam for specific conditions to first rule out general medical, toxic, or traumatic conditions in the following population:
OB patients
Patients with undiagnosed acute pain
Symptoms of substance abuse
Symptoms of psychiatric disturbances

13. #10- Receiving Hospital Acceptance
Thou Shall:
Obtain and document acceptance from receiving hospital

14. #11- Outline Transfer Risks
Thou Shall:
Complete written certificate indicating:
Risks and benefits of transfer
That benefits outweigh the risks

15. #12- Transfer with Support
Thou Shall:
Provide transfer to receiving hospital via:
Qualified transport personnel
Medically appropriate vehicles
Adequate life support equipment
Note: Private auto does not meet standard unless signed refusal by patient

16. #13- Provide Records with Patient
Thou Shall:
Send copies of the following with patient to receiving facility:
Medical records
Laboratory results
Reports
Consultation Records

17. #14-Physician Failure to Respond
Thou Shall:
Provide name of on-call physician whose refusal to respond resulted in patient transfer to another facility

18. #15- Consent to Transfer Thou Shall:
Obtain written consent to transfer from:
Patient
Responsible party
Provide documentation to justify failure to obtain written consent

19. 16#- Written Refusal of Services
Thou Shall:
Obtain written refusal of services (exam, treatment, ambulance or transfer) by patient or responsible person
Refusal must contain specific risks of refusal and advantages of consent

20. #17- Document, Document, Document
Thou Shall:
Document the following:
History
Physical exam
Monitoring results
Intervention results
Note: Failure to document intake & discharge vitals are not mandated but have repeatedly resulted in citations regarding Medicare conditions of participation.

21. #18- Ongoing Reassessment
Thou Shall:
Reassess and document patient findings as condition or category warrants
Note: Failure to reassess during extended waiting times and during course of treatment frequently results in citations

22. #19- Post EMTALA sign Thou Shall:
Post sign that explains patient’s rights under the law in any area of hospital or remote site that qualifies as dedicated Emergency Department

23. #20- Report Violations Thou Shall:
Report suspected or possible violation by another facility that resulted in improper receiving of patient immediately to your supervisor or manager
Report refusal by another facility with special services to accept patient from your facility
Note: Organization has an obligation under the law to report violations within 72 hours to authorities