Entrances and Signage

Signs are posted in ALL entrances, waiting areas, registration areas, triage areas and treatment areas.

Posted signs give information about the person's right to a Medical Screening Examination (MSE) regardless of the ability to pay.

Signs are clearly visible from a distance of 20 feet or the expected vantage point of the patron.

The signs are in the languages of the population(s) most frequently served by the facility.

Triage Process

The waiting area is visible to triage staff so that patients can be monitored.

Patients are directed to triage when they present for care.

A risk report is generated when a patient leaves before of after triage but before MSE.

Patients are informed to notify staff if they choose to leave before the MSE.

Patients who Leave Without Being Seen (LWBS) or Leave With Out Treatment (LWOT) are asked to sign a "Leaving Against Medical Advice" form or "Informed Refusal of Care" form.

There is a reassessment policy for patients in triage who have not yet had an MSE.

Registration Process

Initial information collected from patients presenting for care include only basic information such as name, date of birth, chief complaint, date, time and mode of presentation. (Quick Reg)

Initial registration information (collected prior to the MSE) is documented on the central EMTALA log.

The MSE is not delayed for registration process.

The registration staff have a script to address patients who insist on discussing insurance coverage prior to the Medical Screening Examination (MSE).

Preauthorization of services with insurers does not occur until after the MSE has been conducted.

Stabilizing Treatment

Stabilizing treatment is performed within the capability of the facility and staff.

Physicians are presenting to the facility when called and in compliance with timeframes set forth in organization policy.

There is a communication process between the clinical staff and the registration staff so that any required prior authorization can be sought once stabilization has been initiated.

Transfers Out

Transfer paperwork documents that individuals with unstabilized EMCs are initiated either by a written request for transfer or a physician certification regarding the medical necessity for the transfer.

The medical record documents that the risks and benefits of transfer were discussed with the patient.

The physician documents certification that the benefits outweigh the risks of transfer (focus should be on the patient's complaints, symptoms, and diagnosis).

Transfer documentation demonstrates that there is an accepting physician (name) at the receiving facility.

Documentation reflects the name of the person at the receiving facility who accepts the patient on behalf of the facility.

Pertinent medical records are transferred with the patient.

Transfers In

There is a transfer IN log to document information regarding requested transfers into the facility.

The transfer-IN request log contains the date and time of the request.

The transfer-IN request log documents the requesting facility.

The transfer-IN log documents service availability at the receiving hospital.

The transfer IN log documents whether the transfer was accepted or denied.

The transfer IN log documents the reason for denial if applicable.

Document Review - Policies and EMTALA Log

The central EMTALA Log documents the date and time of each patient's presentation for care.

The central EMTALA Log documents the chief complaint of patients presenting for care (preferably in patients' own words).

The EMTALA Log documents the dates and times of final disposition.

The EMTALA Log documents the final disposition (e.g. admitted, transferred, jail, died, AMA, LWOT, etc.)

There is a reassessment policy for patients in triage who have not yet had an MSE.

The EMTALA policy is up to date for regulatory changes and interpretive guidance changes.

The EMTALA policy defines "comes to the emergency department."

The EMTALA policy defines "dedicated emergency department."

The EMTALA policy defines obligations for non-DED off-campus departments.

The EMTALA policy defines cessation of EMTAL obligations upon inpatient admission.

The EMTALA policy defines requirements for back-up arrangements for on-call coverage that are to be documented in policy.

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.