Treating Staff, EMS, Friends, Colleagues, Etc.[(]
Risk Reduction Guidelines
The Situation
Often the emergency physician or mid-level provider is approached while on duty in the emergency department by hospital staff, friends, EMS personnel, medical staff members, family members of a patient in the department or others to render a casual medical opinion or treatment, or write a prescription or write a refill for a prescription. Generally, the requester is not formally registered as a patient. This presents an awkward situation for the provider, as the expectation is that the provider fulfills the request as a favor, either for convenience and/or to avoid an “ER Charge”. These situations raise several issues that should be addressed by the provider.
Pertinent Issues
· A record of the encounter is often not generated
· Malpractice Insurer may not cover this situation unless the patient registers as a patient and a chart is generated
· EMTALA requirements of a documented “Medical Screening Examination” may not be met unless the patient registers.
· Medical care rendered casually and not according to one’s own standard practices is compromised care.
· Any scheduled drugs, which are prescribed, must be supported by documentation in a medical record. Without a record, the providers DEA license may be in jeopardy.
· EPIC colleagues should not prescribe controlled substances for one another, as this could be a DEA issue.
· Proper and documented Discharge Instructions are often neglected with these casual encounters.
· How are provider charges for the encounter handled? Who gets charged and who gets a courtesy discount?
· Often those requesting the “curbside” medical treatment are insured and are simply trying to avoid waiting for care or paying a deductible.
· EPIC partners maybe at risk for any bad outcomes.
The Solution
· Respond to the request with a positive attitude and request the person to register in order to:
o Give you the opportunity to render your standard level of care.
o Memorialize the encounter in a medical record
o Adhere to the hospital’s and the company’s policies that require that a medical record for all care given by the providers in the emergency department.
· Use the Script: “They won’t let me see you or write prescriptions without you being registered.”
· When appropriate and at the provider’s discretion, a “Discount at Time of Service” may be given for the provider’s professional fee.
· Any care or medical opinion given should be adequately documented in a permanent record.
[(]d It is neither the purpose nor intent of these guidelines to serve as a final authoritative source on any medical condition, treatment plan, or clinical intervention, nor should these guidelines be used to rigorously define a rigid standard of care that should be practiced by all clinicians. These guidelines provide the medical provider with a reasonable clinical guide that is composed of suggestions and opinions of EPIC. These guidelines are a general reference resource and clinical roadmap designed to assist the medical provider. These guidelines cannot replace the clinical judgment of the medical provider and cannot possibly describe every possible aberration, nuance, clinical scenario, or presentation and cannot define standards for clinical actions or procedures.