> can an ED send a patient to another ED
> for further evaluation (for pediatric expertise)
Yes, a patient may be transfered from one ED to another, especially for a
higher level of care (peds tertiary center, trauma center). This does fall
under EMTALA. As with any transfer of care, the transfering physician must
have spoken with an accepting physician at the receiving hospital,
document the reason for the transfer and indicate that within his/her
clinical judgement the patient is stable for transfer.
Under HCFA guidelines, "stable" means that there is "no risk of material
deterioration". (Note, stability has nothing to do with the patient's
cardiovascular status, etc).
If the patient is not stable then the transferring physician needs to
indicate why the benefits of the transfer outweigh the risks, e.g.
speciality care that is unavailable at the transfering facility.
One more point on patient transfer. EMTALA also requires that a copy of
the patient's ED record, including labs and x-rays, be sent with the
> and can an inpatient be
> transfered to another ED for eventual admission (the ED evaluation would be
> used to determine if the child needs an ICU or general floor)?
This one is a little trickier. EMTALA does not directly address this
issue. However, most third party payors (including Medicare and Medicaid)
generally will only pay for transfers to a higher level of care, e.g. a
community hospital general ward to a tertiary care center or PICU. While
many hopsitals will have the patient stop in the ED to be "eyeballed",
there is a very slim chance you would be paid for an ED E&M code.
> situations do not seem to be effected by COBRA ... or are they?
As with most things dealing with ED's the COBRA (EMTALA) is always waiting
to bite. The group should remember that any physician fine under EMTALA
cannot be paid by anyone but you! An EMTALA violation also puts your
hospital's Medicare/Medicaid privilages at risk.
I would encourage you to use the resources at the AAP (Section on
Emergency Medicine) and ACEP to help you keep abreast of changes in the
Jeff Linzer MD MICP
Division of Emergency Medicine
Egleston and Hughes Spalding Children's Hospitals
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