Learning the developments in EMTALA jurisprudence through the lens of John West's "case law update".

This article covers three recurring issues concerning the federal law known as the Emergency Medical Treatment and Labor Act (EMTALA) that keep popping up in John West's Case Law Update case updates, and consistently bedevil hospital risk managers. First, what exactly constitutes an "appropriate" medical screening examination; second, when is a patient actually "stabilized' under EMTALA; and third, does the EMTALA obligation really "disappear" when a patient is admitted to the hospital? The editors wanted to analyze topics that challenge the courts to "get it right" on the law and that drive risk managers crazy. EMTALA is the "poster child" for such a topic.

Improving handoffs in the emergency department.

Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure that handoffs supply valid and useful shared understandings between providers at transitions of care. The purpose of this article is to provide the most up-to-date evidence and collective thinking about the process and safety of handoffs between physicians in the ED. It offers perspectives from other disciplines, provides a conceptual framework for handoffs, and categorizes models of existing practices. Legal and risk management issues are also addressed. A proposal for the development of handoff quality measures is outlined. Practical strategies are suggested to improve ED handoffs. Finally, a research agenda is proposed to provide a roadmap to future work that may increase knowledge in this area.

EMTALA and the ethical delivery of hospital emergency services.

This article examines the role and impact of EMTALA on the ethical delivery of hospital-based emergency services, primarily through close inspection of three of the core EMTALA mandates: the medical screening examination, the duty to accept patients in transfer from less capable facilities, and the requirement that the hospital provide on-call physician services to the emergency department to help stabilize patients with emergencies or help accept patients in transfer. Hospital and physician responses to these mandates, such as triaging/screening patients away from the emergency department, avoiding the application of EMTALA, refusing to accept inpatients with emergencies in transfer, and devising ways to avoid on-call duties, are analyzed in some detail.