Does the Emergency Medical Treatment and Labor Act Affect Emergency Department Use?

Background

Emergency departments (EDs) face increasing patient volumes and economic pressures. These problems have been attributed to the Emergency Medical Treatment and Labor Act (EMTALA).

Study objective

To determine whether modifying EMTALA might reduce ED use.

Methods

We surveyed ED patients to assess their knowledge of hospitals’ obligations to treat all patients regardless of insurance and to determine whether knowledge is associated with ED use.

Results

Among 4136 study subjects, 72% reported awareness of the law. Sixty-one percent of subjects were moderate ED users (≥ 1 additional ED visit in 12 months). Moderate users more often knew the law (74% vs. 70%, p = 0.005). Multivariate regression showed that factors associated with moderate use were: awareness of EMTALA (odds ratio [OR] 1.44; 95% confidence interval [CI] 1.24–1.67), adult patient (OR 1.94; 95% CI 1.69–2.22), and government insurance (OR 2.67; 95% CI 2.30–3.08) or uninsured (OR 1.72; 95% CI 1.42–2.08). Only 8% of subjects were high-frequency users (≥5 visits). High-frequency users were more often aware of EMTALA (78% vs. 72%, p = 0.02). Covariates associated with high frequency were EMTALA awareness (OR 1.69; 95% CI 1.28–2.24), adult patient (OR 2.59; 95% CI 2.00–3.36), and government insurance (OR 3.73; 95% CI 2.76–5.06) or uninsured (OR 3.77; 95% CI 2.65–5.35).

Conclusion

Many patients know that the law requires hospitals to provide care. This knowledge is associated with more frequent ED use. EMTALA changes might reduce ED use, but broader policy implications should be considered.     

Do Emergency Physicians Improve the Appropriateness of Emergency Transfer in Rural Areas?

Background

Until recently, there have been few studies on the transfer of patients from emergency departments (EDs) overall, as such studies were limited primarily to trauma patients.

Emergency medicine in México

In the past decade, México, with the third largest population of any country in the Americas, has experienced rapid growth in Emergency Medicine education. Emergency Medicine residency programs began in México City in 1986 and in 1991, spread throughout the country when the Medical Institute of Social Services (IMSS) instituted programs at their specialty hospitals. Although pre-hospital care is still rudimentary in many parts of the country and there are insufficient numbers of trained emergency physicians to staff the nation’s Emergency Departments, the growth of the specialty is helping to improve the quality of medical care in México. This article discusses the current condition of and prospects for Emergency Medicine in México within the context of its medical system, and outlines objectives and guidelines for future developments.     

Emergency preparedness--is your OR ready?

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EMERGENCY SITUATIONS only recently have come to include terrorist threats, such as radiation, biological and chemical attacks, and bombings.

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THE IMPORTANCE of emergency preparedness in health care facilities has increased as a result of recent terrorist threats.

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PERIOPERATIVE LEADERS must meet the challenge of preparing their departments for a wide range of potential disasters.

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THIS ARTICLE describes how a facility can prepare for both natural and man-made disasters and reviews modifications to the Joint Commission on Accreditation of Healthcare Organizations' disaster preparedness standards. AORN J 79 (June 2004) 1276-1283.

     

Development of the Emergency Medicine in Hong Kong

The Hong Kong College of Emergency Medicine (HKCEM)will celebrate its 10~(th) anniversary in October 2006.There is certainly a much longer period of development of Emergency Medicine(EM)in Hong Kong.We shall try to describe the development in the last 5 decades.     

The Emergency Medicine−Focused Review of Cholangitis

Background

Cholangitis is a life-threatening infection of the biliary tract. Historically, the mortality secondary to cholangitis approached 100%. However, with early recognition, antibiotics, resuscitation, and surgical or endoscopic intervention, patient outcomes have significantly improved, although there is still progress to be made.

Emergency Nurses’ Guide to Neonatal Lumbar Punctures

A neonatal lumbar puncture can present many challenges for emergency nurses that may not be seen with older children or adults. It is imperative that emergency nurses have the knowledge and training related to the procedure to ensure a positive process for the neonate, involved family and health care team members, as well as the overall outcomes of the procedure. This paper provides a practical guide to the essential knowledge for a neonatal lumbar puncture in the emergency department. The main points conveyed in this paper include considerations such as indications for a neonatal lumbar puncture, how to prepare for the procedure, how to position the neonate, possible complications, and caregiver support.     

Evaluating an Emergency Medical Services—Initiated Nontransport System

Objective. To evaluate both factors predicting nontransport andmortality rates in an emergency medical services system with a nontransport policy. Methods. We reviewed data from 1,581 transported andnontransported patients from October 2001 to July 2003. Patients who refused transport against medical advice were excluded. Extracted data included demographics, run characteristics, chief complaint, andclinical impression. Transported andnontransported patients were compared using Mann–Whitney U or chi-square tests. Logistic regression identified factors predictive of nontransport. A Social Security Death Index search determined 30-day mortality. Results. A total of 1,501 runs involving 1,059 patients were included. Median age was 60 years (range, 0–97 years). A total of 427 (40.4%) were male; 107 (10.2%) were nonwhite. Older patients were more likely to be transported (odds ratio, 1.03; confidence interval, 1.02–1.03). Race, frequency of calls, mutual aid, or time of day did not significantly influence probability of transport. Patients with cardiovascular, respiratory, andgastrointestinal complaints were more likely to be transported than those with other conditions (P < 0.005); patients with endocrine, trauma, andmiscellaneous complaints were less likely to be transported (P < 0.003). Patients with renal, obstetrics/gynecology, andhema matology/oncology were complaints all transported. Mortality was 4.9% (confidence interval, 3.9%–6.2%) for transported patients and1.0% for those not transported (confidence interval, 0.2%–3.7%). Conclusions. Age is a determinant when deciding on transporting patients. Patients with complaints with potentially higher acuity were transported most often. Only two nontransported patients died within 30 days, although it is unknown whether initial transport would have changed their mortality. Our data suggest that emergency medical services–initiated nontransport is influenced only by age andchief complaint andmay not result in significant mortality.