Pediatric emergency medicine trisk 0136 0136
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Reassessment
With ever increasing ED crowding, patients often must wait to see a provider
after triage is completed beyond recommended ESI-based time frames. Patients in
the waiting room should be reassessed for progression of illness or injury and
response to triage interventions. Individual departments should institute a
reexamination plan based upon their available resources and patient flow, keeping
in mind that assessment itself is strictly a nursing function, and cannot be
delegated to unlicensed support staff.
EMTALA
To ensure appropriate access to emergency services, Congress passed the
Emergency Medical Treatment and Active Labor Act (EMTALA) as part of the
Consolidated Omnibus Budget Reconciliation Act (COBRA) in 1986. EMTALA
requires all hospitals participating in Medicare programs to provide a medical
screening examination (MSE) to each patient who presents to the facility
requesting examination or treatment for an emergency medical condition (EMC)
regardless of ability to pay, legal status, or citizenship. The MSE must be
completed by a physician or qualified medical personnel (e.g., approved member
of medical staff). An EMC is that which places the individual’s health, organs, or
bodily functions at serious risk. Once an EMC is identified, stabilizing treatment
must be provided. If the facility is unequipped to appropriately stabilize, transfer
to a higher level of care should occur with the patient, legal guardian, or power of
attorney’s consent. There are numerous directives which address discrimination,
appropriate treatment area signage, insurance gathering, compliance reporting,
and documentation standards. As such, participating hospitals should clearly
address each EMTALA requirement in institutional policies and procedures.
Triage nurses and emergency room medical staff should have a sound
understanding of current EMTALA guidelines and institutional practices to
ensure continued compliance.
TRENDS IN TRIAGE
Quality indicators evaluating efficiency and effectiveness are often used in ED
settings. The overarching goal is to improve safe patient throughput while
decreasing left-without-being-seen (LWBS) rates. Recognizing the need to
improve throughput in pediatric EDs, the Child Health Corporation of America
Emergency Department group set a national goal to decrease length of stay (LOS)
in pediatric EDs by 25%. Outcome measures in ED LOS are segmented into
door-provider, provider-decision, and decision to discharge or admit time. In
addition to the aforementioned initiation of nurse-led interventions during triage,
