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From: Jim Chamberlain <[log in to unmask]>
>> The recommendation not to use a physician extender to perform a MSE is
> ridiculous since we use PNP's to provide emergency care and
> Observation Unit care.
>
> So, patients who are nonurgent (e.g. ringworm, diaper rash, etc.) should
> have a higher level of care than ED patients?
>
> Guess that's why these guys are consultants and not practitioners...
>
> Jim Chamberlain
____________________________________________________________________
Using a physician extendor to provide definitive emergency care (as you are
stating) is different from using them for an MSE. The basis for his
recommendation I do not know but I can speculate. Being a JD involved with
keeping track of recent settlements in instances of cobra violations etc
this practice may be less defensible in court.
 
There is a distinction however, between an MSE and providing a definitive
disposition/Rx. The MSE evolved as a reaction to frequent retrospective
denials by MCO's of emergency care. It enabled EDP's to stratify patients
into those who truly needed emergent care and those who did not. Not all
states have the prudent lay person definition of emergency operational at
this time. That would be ideal as Naghma said.
 
It is certainly debatable whether we should have another tier of evaluation
after triage and before definitive care is provided. At least for pedatric
emergency care, where problems generally tend to be "unisystem" without
co-morbidities, I don't believe it is cost effective. It is much more
efficient from the patient as well as ED standpoint, to have one ME
(medical exam) and decide definitive management and (hopefully!!) be
reimbursed for it. Whether this is done by a PNP ( as you'll do) or MD is
an issue which individual ED's need to decide.
 
Naghma, I am curious, since you are contemplating implementing MSE's at
Eggleston, who would be providing them and have you looked at the financial
viability of such an endeavour?
 
Thanks
 
Jay Pershad
"We care for wee folks"
 
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