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Policy Statements
Deferral of Care After Medical Screening ofEmergency Department Patients
[Ann Emerg Med. 2015;65:130.]
The American College of Emergency Physicians (ACEP) believesthat every patient who seeks care in the emergency department (ED)should receive appropriate and necessary medical care. Although thiscare should ideally be provided in the ED, ACEP recognizes that inlimited circumstances, deferral of care from theEDmaybewarranted,but that strict safeguards are necessary to protect such patients andensure that deferral of care is appropriate and safe for the patient.
In situations in which it is determined that a patient has noemergency medical condition and that his or her care can besafely deferred, specific and concrete standards must be adoptedby the hospital to ensure patient access to an alternative settingand timely, appropriate treatment.
Minimum steps before any deferral of care should include thefollowing:� a standardized process to ensure that all patients presenting
for medical care receive an appropriate medical screeningexamination by a qualified medical provider as identified inthe hospital by-laws or in the rules and regulations governingthe medical staff, following governing body approval;
� appropriate medical treatment for emergency medicalconditions, as is required by the Emergency Medical Treatmentand Labor Act;
� the determination that the medical screening examinationidentifies no emergency medical condition requiring immediatetreatment in the ED, and that deferral of care is not likely toresult in a significant deterioration in the patient’s medicalcondition or the unreasonable exposure of the patient’s family ormembers of the community to a communicable disease;
� the determination by the hospital, in advance of any deferralof care, that at least 1 appropriate alternative setting andprovider is available such that the patient can obtain timelyevaluation and treatment, whether or not the patient hashealth insurance coverage; and
� the determination by the hospital, in advance of deferral ofcare, that the patient will be able to make and receive a timelyappointment in this alternative setting with a qualified provider.Emergency physicians are responsible for the care of patients
they are treating in the ED after a patient-physician relationshiphas been established. They must have the opportunity tocomplete their patients’ care if they believe it is appropriate, evenif no emergency medical condition exists.
Deferral of care from the ED can have significant risks to patientsand providers. ACEP strongly opposes deferral of care for patientspresenting to the ED without the aforementioned safeguards.
EDs using deferral-of-care processes should have activeemergency physician involvement in their development to ensuresafe patient care and appropriate disposition.
Emergency physicians should not be compelled to participatein deferral-of-care strategies unless the safeguards for safe deferralas detailed in this policy are followed.
130 Annals of Emergency Medicine
Emergency physicians are responsible for the medical care ofpatients they are treating in the ED after a patient-physicianrelationship has been established and must have the opportunityto further evaluate and treat their patients to ensure stability.
Approved June 2014Revised and approved by the ACEP Board of Directors titled
“Deferral of Care After Medical Screening of EmergencyDepartment Patients” June 2014
Revised and approved by the ACEP Board of DirectorsJanuary 2007
Originally approved by the ACEP Board of Directors titled“Medical Screening of EmergencyDepartment Patients”April 2006
http://dx.doi.org/10.1016/j.annemergmed.2014.10.026
Responsibility for Admitted Patients
[Ann Emerg Med. 2015;65:130.]
The American College of Emergency Physicians (ACEP)believes that the best patient care occurs when there is noambiguity about which physician is responsible for each patient.Because admitted patients are sometimes held in the emergencydepartment, confusion may occur when one determineswhich physician is responsible for an admitted patient’s care.Emergency physicians may provide care to any admitted patientduring a medical emergency. Emergency physicians should notbe obligated to provide care during a medical emergency unlessindemnified by the hospital or covered by their professionalliability insurance policy.
For these reasons, ACEP endorses the following principles:� Regardless of the location of an admitted patient within the
hospital, the ultimate responsibility for an admitted patient’smedical care rests with the admitting physician.
� Hospital policy and procedures should clearly delineate thatonce an admitting physician has accepted a patient, he or shehas assumed responsibility for the patient.
Approved June 2014Reaffirmed and approved by the ACEP Board of Directors
June 2014Originally approved by the ACEP Board of Directors October
2007
http://dx.doi.org/10.1016/j.annemergmed.2014.10.025
Emergency Department Patient Advocate Role andTraining
[Ann Emerg Med. 2015;65:130-131.]
The American College of Emergency Physicians (ACEP)supports the use of patient advocates in the emergency department(ED). If EDs choose to use patient advocates, there are a numberof ways in which they can contribute to patient comfort,satisfaction, education, and safety, including the following:
Volume 65, no. 1 : January 2015
