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I don't think the new rules require the ED attending to be "at the elbow"
of the resident. Being present in the ED is a key factor. Also the
regulations say that the attending is suppose to be "present" when the key
componet that determines the level of care is made.
 
I think that in the ED, if the patient is presented to you, you physically
eye-ball the patient, and then you detrmine the level of service that has
been provided, you will have met the intent of the regulations.
 
IMHO I agree with the previous comments that the regulations are mostly
directed to attendings who are not physically present (read at home
asleep) when something important is done to the patient (e.g. a procedure
under general anesthesia) by the resident, and the attending bills for
the service.
 
 
Jeff Linzer MD MICP
Division of Emergency Medicine
Egleston and Hughes Spalding Children's Hospitals
[log in to unmask]
 
 
On Fri, 8 Mar 1996, thomas e. terndrup wrote:
 
>
> ...The language indicates a need to be present (read, at the bedside or
> "elbow" of the resident) for the "key" portion of the procedure.  It
> seems we will need to refine what is meant by this key portion.  For
> example, would it be sufficient to be at the bedside at the time when the
> spinal needle was placed at the right location for a lumbar puncture? can
> we place the "key suture" and leave the remainder of the wound closure to
> the resident?
 
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html