Children s Hospital and Health System Patient Care Policy and Procedure

Transcription

1 Children s Hospital and Health System Patient Care Policy and Procedure This policy applies to the following entity(s): Children s Hospital of Wisconsin Milwaukee Children s Urgent Cares SUBJECT: Transfers Out of CHW per the Emergency Medical Treatment and Active Labor Act (EMTALA) POLICY Children s Hospital of Wisconsin (CHW) will provide necessary medical care to all individuals presenting to the hospital within the capabilities of the facility. There will be no delay in the provision of an appropriate medical screening examination in order to inquire about the individual s method of payment or insurance status. Only individuals that meet certain requirements can be transferred to other facilities for care. DEFINITIONS: Emergency Medical Condition I. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances, and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in (a) placing the health of the individual (or with respect to a pregnant woman; the health of the woman, or her unborn child) in serious jeopardy; (b) serious impairment to bodily functions; or (c) serious dysfunction to any bodily organ or part; or II. With respect to a pregnant woman who is having contractions (a) that there is inadequate time to effect a safe transfer to another hospital before delivery; or (b) that transfer may pose a threat to the health or safety of the woman or the unborn child. Note: Any individual that has been deemed to be a danger to self or others, by definition, has an emergency medical condition. Medical Screening Exam An on-going process required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an emergency medical condition exists. Such screening must be done within the hospital s capabilities and available personnel, including on-call physicians. Stabilized With respect to an emergency medical condition, that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of an individual from a facility. An individual will be deemed stabilized if the treating physician of the individual with an emergency medical condition has determined, within reasonable clinical confidence, that the emergency medical condition has been resolved. Page 1 of 6

2 Transfer The movement (including the discharge) of an individual to outside a hospital's facilities at the direction of any person employed by (or affiliated or associated with, directly or indirectly) the hospital, but it does not include such a movement of an individual who leaves the facility against medical advice. EMTALA Obligation Termination The hospital must provide a medical screening examination and appropriate care until the condition ceases to be an emergency, the individual is admitted to the hospital or until the individual is properly transferred to another facility. Procedure A. INDIVIDUALS WHO COME TO THE DEDICATED EMERGENCY DEPARTMENT FOR NONEMERGENCY SERVICES 1. When an individual comes to the dedicated emergency department for non-emergency services, and from the nature of his or her request it is clear that the individual is not making a request, or having a request made on his or her behalf, for examination or treatment for an emergency medical condition, the hospital is not obligated to conduct a comprehensive medical screening examination. 2. The medical screening examination may be limited to one or more of the following: (i) individual s statement that he/she is not seeking emergency care; (ii) brief questioning by a qualified medical person that is sufficient to establish that there is no emergency condition; (iii) obtain the individual s history, conducting an examination relevant to the individual s complaint, to determine whether there is an emergency medical condition; and (iv) document that the individual does not have an emergency medical condition. 3. EMTALA does not apply to preventative care services. 4. Requests by law enforcement for medical clearance of persons for incarceration or blood alcohol or other tests to be used as evidence in criminal proceedings will require a medical screening examination. B. INDIVIDUALS WHO COME TO THE DEDICATED EMERGENCY DEPARTMENT FOR EMERGENCY SERVICES 1. Perform medical screening examination to determine the presence of an emergency medical condition. If an emergency medical condition is not present, there is no further EMTALA requirement. 2. If an emergency medical condition is present, treat and stabilize within capacity and capabilities until the condition ceases to be an emergency, the individual is admitted or the individual is transferred. C. TRANSFERRING TO ANOTHER FACILITY PHYSICIAN RESPONSIBILITIES 1. Determine that the individual is stable for transfer. 2. If the individual is not stable, transfer may occur if the medical benefits reasonably expected from Page 2 of 6

3 the provision of appropriate medical treatment at another facility outweigh the risk to the individual, or in the case of a woman in labor, to the unborn child, from being transferred. 3. Order the transfer. 4. Complete appropriate documentation, including the transfer summary and the EMTALA transfer form. 5. Determine and order the level of care during transfer and which personnel are required to accompany the patient. 6. Determine and order the mode of transportation and special needs during transfer. Make arrangements with the accepting physician at the receiving institution; obtain agreement from the receiving facility that it has available space and qualified personnel to treat the individual and that it will accept the transfer and provide appropriate medical treatment. 7. The inpatient RN or provider can contact the Health Information Management department who will print hardcopies of the patient s chart. Or, staff (including EDTC staff) can print the transfer documents by printing the Transfer Report in Quick Release. The documents should be sent with the patient to the new facility. 8. Inform the patient/parent of the reasons for the transfer, and obtain consent and signature. REFUSAL TO TRANSFER If the individual (or parent) refuses the transfer, give an explanation of the risks and benefits of the transfer. If the individual continues to refuse to transfer, document in the medical record the proposed transfer was refused by or on behalf of the patient. Take reasonable steps to obtain the written informed refusal of the transfer from the individual on the Informed Refusal of Transfer Form (see Addendum B) and file in the medical record. If the individual has a psychiatric or mental health issue and refuses the transfer to a mental health facility, staff need to decide if a police hold is necessary. HUC Responsibilities: 1. Obtain copy of the medical record to be sent with the individual. 2. Prepare all documents to be sent with the patient. Nursing Responsibilities: 1. Complete appropriate documentation on the Transfer Checklist. 2. If the CHW Transport Service is the ordered transport provider, notify Children s Transport via the Transport Hotline of the request for transfer ( ). 3. The Transport Nurse Clinician ( ) may be utilized, as a resource for transfers not accomplished through the transport team. If the patient is not being transferred by Children s Transport, notify the appropriate transfer vendor as determined by the transferring physician, or designee. 4. Perform and document the patient s assessment before transfer. 5. Confirm arrangements with the receiving institution and complete RN (referring) to RN (receiving) transfer report. 6. Ensure that copies of the medical record accompany the patient during transfer. The inpatient RN or provider can contact the Health Information Management department who will print hardcopies of Page 3 of 6

4 the patient s chart. Or, staff (including EDTC staff) can print the transfer documents by printing the Transfer Report in Quick Release. The documents should be sent with the patient to the new facility. 7. If the patient/parent refuses the transfer, assist the physician in taking reasonable steps to obtain the written informed refusal on the Informed Refusal of Transfer Form and file in the medical record. References: EMTALA: Emergency Medical Treatment and Active Labor Act EMTALA Interpreting and Complying with the Federal Transfer Law, Louise M. Joy, Esq. Related CHW Policies and Procedures: Administrative: EMTALA Requirements to Report a Suspected Violation Patient Care: Code Blue for Emergency Medical Situations and the Emergency Medical Treatment and Active Labor Act (EMTALA) Patient Care: Emergency Detention Patients with Mental Health Issues in Police Custody or Being Held for Police Custody Patient Care: Transition Planning/Discharge of Patient Patient Care: Transporting and Monitoring Patients going to Froedtert Hospital for Ancillary Services and Procedures Patient Care: Transport of Patients within the Hospital Patient Care: Suicide Risk Assessment / Care of the Suicidal or Potentially Suicidal Patient Just in Time Teaching sheet: Transfer to Other Facility from Inpatient Approved by the Medical Executive Committee 08/2013 Approved by JCPC for form and Epic updates 02/2014 Full footer: Supersedes: Transfer Emergency Room Evaluation and Stabilization; ER Transfers 7/2001, 03/2002, Transfers out of CHW, includes EDTC, all Units and Depts as per EMTALA 09/2002. Emergency Medical Conditions Medical Screening Exam, and Transfers out of CHW 08/2013 Reviewed: 02/2006; for new tower 10/2008 No change Revised: 08/2013 and name change; 04/2014 Page 4 of 6

5 Addendum A: Transfer to Other Facility Consent and Order Page 5 of 6 Revised: 04/2014 Transfers out of CHW per the Emergency Medical Treatment and Active Labor Act (EMTALA)/ppp/Process Owner(s): Manager: Risk & EDCT

6 Addendum B Transfer to Other Facility Refusal Informed Page 6 of 6 Revised: 04/2014 Transfers out of CHW per the Emergency Medical Treatment and Active Labor Act (EMTALA)/ppp/Process Owner(s): Manager: Risk & EDCT