Healthcare Laws
a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs
What is an emergency condition
An ambulance presents to the ED with a 19-year-old patient with a suspected medication overdose. Her friend found her lethargic and “not acting right,” so they called 911. Vitals are BP 104/66 mm Hg, HR 128 beats/minute, RR 8 breaths/minute, T 36.6°C (97.8°F), and SpO2 90% without supplemental oxygen.
What is ESI 1
What is ESI 4
An X-ray counts as one resource. Simple splinting or a prescription for crutches/oral NSAIDs do not count as additional ESI resources
I just turned my back for a minute," cried the mother of a 4-year-old. The child was pulled out of the family pool by a neighbor who immediately administered mouth-to-mouth resuscitation. The child is now breathing spontaneously but continues to be unresponsive. On arrival in the ED, vital signs were: HR 126, RR 28, BP 80/64, SpO2 96% on a non-rebreather
What is ESI 1
This 4-year-old continues to be unresponsive. The patient will require immediate lifesaving interventions to address airway, breathing, and circulation.
This is associated with decreased patient safety and satisfaction
What is left without being seen
This applies to educating and fully informing the patient on a procedure
What is consent
A 58-year-old patient fell outside and presents with right wrist pain. There is no obvious deformity; minor swelling is noted, radial pulse is strong and regular. There was no head injury. Vitals are BP 116/70 mm Hg, HR 82 beats/minute, RR 16 breaths/minute, T 36.9°C (98.0°F), and SpO2 96% without supplemental oxygen.
What is ESI 4
I am a [gasp] 81 year old [gasp] female. I [gasp] started with a [gasp] fever of 101.2*F [gasp] yesterday. Today [gasp] [gasp] [gasp] I can barely breath.
What is ESI 1
An 82-year-old patient from a nearby senior living facility presents with vomiting and diarrhea. Vital signs are BP 90/60 mm Hg, HR 80 beats/minute, RR 28 breaths/minute, T 35.8°C (96.6°F), and SpO2 93% without supplemental oxygen.
What is ESI 2
This patient is hypotensive, hypothermic and tachycardic.
These patients are at a higher risk for adverse events and have worse health outcomes
What are Patients with limited English proficiency.
Language barriers have significant effects on safe and effective healthcare. Inequities in pain management, medical errors, hospital stay duration and return visits to the ED have affected patients
Within what distance is considered "presenting to the emergency department"
What is 250 yards.
The Centers for Medicare and Medicaid Services (CMS) interpretation of this is that anyone who is on hospital property is considered to have come to the emergency department. Hospital property is defined as the building, sidewalks, parking lots, and any ambulance owned by the hospital, even if it is not on hospital property.
A 22-month-old is brought in by their caregiver who states the toddler has been pulling at their left ear for a couple days with subjective fevers at home. The patient is up to date on immunizations. Vitals are BP 100/62 mm Hg, HR 128 beats/minute, RR 34 breaths/minute, T 38.1°C (100.5°F), and SpO2 99% without supplemental oxygen.
What is ESI 5
What is ESI 2
A 14-year-old patient presents with generalized abdominal pain and vomiting since eating dinner. Vital signs are BP 110/66 mm Hg, HR 100 beats/minute, RR 16 breaths/minute, T 37.2°C (99.0°F), and SpO2 99% without supplemental oxygen.
What is ESI 3
Before a patient leaves AMA, this must be had:
What is a discussion and documentation of the patient’s understanding of the risks of leaving before formal discharge.
The patient would have had a MSE by an advanced provider or physician and have been informed of the risks for leaving and have the capacity to make informed decisions about their health. The institution may have a form for physician and patient to complete with signatures and potentially a reporting system to keep a record of when a patient leaves AMA. Documentation for AMAs must include a discussion and the patient’s understanding of the risks of leaving before formal discharge. Signing a form does not release the hospital or provider from liability, and does not affect billing.
When can I transfer the patient
what is once they are stable
A normal healthy 7-year-old walks into the emergency department accompanied by his father, who reports that his son woke up complaining of a stomach ache. "He refused to walk downstairs and is not interested in eating or playing." The child vomits at triage. Vital signs: T 100.4°F, RR 22, HR 88, BP 84/60, SpO2100%. Pain 6/10
What is ESI 3
At a minimum, this child will need a workup for his abdominal pain, which will include labs and a CT or ultrasound—two resources.
An 81-year-old female is brought in by her daughter because she is "not acting like herself." The daughter states her mother has been unusually sleepy, mildly confused, and refused to eat breakfast or lunch today. The patient denies any pain, short-breath, or respiratory symptoms. Her vital signs are: BP 108/62 mmHg, HR 88 bpm (irregular), RR 18 rpm, Temp 96.8°F (36.0°C), SpO2 95% on room air.
What is ESI 2
Change in mentation= ESI 2
41-year-old male involved in a bicycle accident walks into the emergency department with his right arm in a sling. He tells you that he fell off his bike and landed on his right arm. His is complaining of pain in the wrist area and has a 2-centimeter laceration on his left elbow. "My helmet saved me," he tells you.
What is ESI 3
What is ESI 2
This is a known high-risk ingestion with a high potential for rapid, severe deterioration
Once a person has been deemed “a patient” there are two interventions/care processes that must be completed to fulfill EMTALA.
What are medical screening exam and stabilization
The hospital must provide an appropriate screening examination to determine whether the individual suffers from an emergency medical condition.
Patients who are not stabilized remain at the receiving facility (are not transferred) unless specific requirements are met.
The hospital, within its capability, provides medical treatment necessary to stabilize the patient.
An 18-month-old is brought in by a caregiver stating the child has had fevers and a petechial rash for the past three days. The Pediatric Assessment Triangle reveals the toddler is alert, respirations are unlabored, and the skin color is normal for the patient. They are not up to date on immunizations. A petechial rash is present. BP 98/60 mm Hg, HR 140 beats/minute, RR 36 breaths/minute, T 39.3oC (102.8oF), and SpO2 99% without supplemental oxygen.
What is ESI 2
This unvaccinated child, while appearing stable, will need an extensive evaluation with labs and consultation
A 3-week-old infant is brought to triage by his parents because he feels warm and is refusing to nurse. The infant is sleeping in his mother's arms but opens his eyes briefly when moved; he appears pale. His triage rectal temperature is 101.2°F (38.4°C), HR 165 bpm, and RR 48 rpm.
What is ESI 2
Infants < 28 days with fever = ESI 2
A 32-year-old female presents to the emergency department complaining of shortness of breath for several hours. No past medical history, +smoker. Vital signs: RR 32, HR 96, BP 126/80, SpO2 93% on room air, T 98.6°F. No allergies, current medications include vitamins and birth control pills.
What is ESI 2
This 32-year-old female with new-onset shortness of breath is on birth control pills. She is a smoker and is exhibiting signs and symptoms of respiratory distress (SpO2 and respiratory rate.) Based on history and signs and symptoms, a pulmonary embolus, as well as other potential causes for her respiratory distress, must be ruled out.
These are the steps involved if a critically ill patient presents to triage:
What are:
Quick assessment
Call charge nurse
Call team stat
Bring patient back to C1/2
Give report to primary nurse