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Feds Clarify Hospital Triage Rules in Event of H1N1 Frenzy

Cheryl Clark, for HealthLeaders Media, August 25, 2009

Hospital and public health officials who worry about being deluged this fall by sick and worried well patients fearing H1N1 now have comforting federal guidance on how to re-direct crowds without violating the law.

First, jammed hospital emergency departments can set up alternate screening sites elsewhere on campus, with personnel stationed outside the emergency department to log in and redirect patients seeking care to that alternate site.

This triage system is acceptable as long as the personnel are qualified physicians, RNs, physician's assistants or nurses trained to perform such exams.

Second, hospitals may set up screening at an off-campus site if it is controlled by the hospital. And hospital and community officials may encourage the public to go to these sites instead of the hospital for screening for influenza-like illness.

Third, hospitals and community health officials may encourage the public to go to those sites instead of the hospital for influenza screening.

And fourth, the required medical screening exam does not need to be an extensive work-up in every patient's case.

The guidance was issued in a fact sheet distributed to hospitals by the Centers for Medicare and Medicaid Services in response to hospital and agency concerns.

However, there are some important caveats.

A hospital may not tell individuals who have already come to the ED to go to the off-site location for the exam. And the hospital cannot announce or advertise the off-site location as a place that provides care for general, urgent, unscheduled emergency medical conditions, other than those involving influenza-like illness.

Hospital and public health officials concerns stem from requirements under the federal Emergency Medical Treatment and Labor Act (EMTALA). The law says hospital emergency rooms that participate in the Medicare program must provide medical screening exams to any patients who arrive at their doors, regardless of the patients' ability to pay.

If patients have an emergency medical condition, the hospital must treat and stabilize the patient within its capability or transfer to a hospital that does have the capability and the capacity to do so. Receiving hospitals with appropriate capabilities and capacity cannot refuse those transfers.

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