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Defining an emergency department under EMTALA

Compliance Monitor, July 28, 2006

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Q: We are a free-standing psychiatric hospital without an ED. We don't advertise or hold ourselves out as a place that provides care for emergency medical conditions, however, sometimes we do have walk-in patients. All of our patients are admitted because they require inpatient levels of psychiatric care. How do the EMTALA rules for defining an emergency department (such as the one-third rule) apply to us? Should we determine whether one-third of our cases are walk-ins, without schedules appointments?

A: CMS views taking care of psychiatric walk-ins as an emergency psychiatric function. Don't think in terms of the ED being a separate set of four walls. Think in terms of the function being provided and whether one-third of the patients are walk-in patients seeking urgent care.

This are is fertile for state surveyor investigations. It's a good idea to have policies in place to deal with these situations. I think CMS is going to hold you to some of the standards under EMTALA, even though you could argue against this.

This question is excerpted from HCPro's book A Practical Guide to EMTALA Compliance, written by Joseph Gatewood, Esq., Loren Johnson, MD, FACEP and Ellen Arrington, RN, BSN.

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