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Would a triage nurse be considered an initial medical screening if the nurse is a RN and not a physician extender?

Compliance Monitor, November 12, 2004

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Editor's note: The following is an EMTALA-related answer to last week's question.

A: According to EMTALA, every person who comes to the ED must receive a medical screening exam to determine if there is an emergency medical condition. There is a lot of discussion regarding whether this medical screening must be provided by a physician or whether it can be provided by a specially trained nurse.

The answer lies within the laws of each state. If a state has defined this to be within the scope of practice for a nurse within that state, then a nurse may provide a medical screening exam. In the state where I live, nurses may not provide the screening exam so it must be a physician provider (or nurse practitioner).

There is another issue here in that triage does not equate to a medical screening exam. Briefly, triage is designed to determine the immediacy of the problem (can the patient sit in the waiting room or do they need to be seen immediately).

The medical screening exam must be designed to answer the question of whether there is an emergency medical condition present. If there is no emergency medical condition, the EMTALA responsibilities have been met. If there is an emergency medical condition, the hospital has additional responsibilities to fulfill.

This question was answered by Janet V. Gallaspy, BS, RN, CPUR, CPC-H, medical auditor, corporate compliance, Forrest General Hospital, Hattiesburg, MS.

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