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The challenge of emergency department call coverage

Credentialing Resource Center Connection, April 17, 2008

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Sally J. Pelletier, CPMSM, CPCS, is a consultant with The Greeley Company, a division of HCPro, Inc., specializing in the areas of credentialing and privileging.

Dear credentialing colleague:

The seemingly unsolvable problem facing many hospitals today is the challenge of managing emergency department (ED) call coverage issues. Like the commercial that informs us that you can get high cholesterol from a variety of sources including your Uncle Jim, Aunt Gertrude, or even from your favorite dessert, problems surrounding ED call coverage come from a variety of different sources. Contributing factors include but are not limited to: 

• The medical executive committee (MEC) has not clearly defined call coverage requirements by specialty
• Stakeholders have yet to establish principles of fairness that address the needs of the organization, the community, and the physicians
• Physicians limit their privileges and insist that because they do not hold certain privileges they cannot take call
• Physicians expect to be paid by the hospital or they refuse to take call
• If physicians are reimbursed, but then that initial reimbursement amount is reduced, the result is that physicians may want to spend more time in their offices or want to be paid for call
• Physicians desire to maintain a manageable work-life balance, and think ED call will disrupt this
• There is not a clear understanding of what the federal Emergency Medical Treatment and Active Labor Act (EMTALA) requires

However, this column is not dedicated to a discussion of all the intricacies that go into developing a workable solution to ED call at your organization. It does suggest one simple step that, if implemented, helps to manage this conundrum as it relates to privileging: add language to privileging forms that addresses the EMTALA requirements and links it to MEC requirements. The language can simply be stated as follows: “Assess, stabilize, and determine disposition of patients with emergent conditions consistent with medical staff policy regarding emergency and consultative call services.”

Physicians who hold privileges in their respective specialty areas should be competent to come in, assess and stabilize the patient, and transfer care as appropriate. For example, an orthopedist who specializes in hips or knees would be competent to come in, assess a patient with a dislocated shoulder, and make the appropriate determination as to the transfer of care.

The problem of ED call coverage is not easily fixed and requires thoughtful discussion and negotiation between all parties involved. However, organizations can provide guidance and clarification within their privileging forms by adding language that addresses what is required by EMTALA.

Remember, credentialing has no other master than the patient.

That’s all for this week.

All the best,

Sally J. Pelletier, CPMSM, CPCS
http://www.greeley.com/consulting.cfm

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