Vascular Surgery Related Violations Of The Emergency Medical Treatment And Labor Act
Thomas W. Cheng, M.S., Stephanie D. Talutis, M.D., M.P.H., Alik Farber, M.D., Douglas W. Jones, M.D., Jeffrey A. Kalish, M.D., Jeffrey J. Siracuse, M.D..
Boston University, Boston, MA, USA.
OBJECTIVES: The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law established in 1986 to ensure that patients who present to an emergency department (ED) receive medical care regardless of means. Violations are reported to the Centers for Medicare and Medicaid Services (CMS) and can result in significant financial penalties. Our study's objective was to assess all available EMTALA violations for vascular surgery related issues.
METHODS: EMTALA violations in the CMS hospital survey database from 2011 to 2018 were evaluated for vascular-related issues. Case details recorded were case type, hospital type, hospital region, reasons for violation, disposition, and mortality.
RESULTS: There were 100 in 7001 patients (1.4%) identified with any EMTALA violation that were vascular surgery related. 83% of EMTALA violations occurred at urban/suburban hospitals. By region, vascular-related EMTALA violations occurred in the Northeast (7%), Southern (57%), Central (18%), and Western (18%) United States. Case types included cerebrovascular (28%), ruptured aortic aneurysms (8%), aortic dissection (11%), other aortic (3%), vascular trauma (15%), venous-thromboembolic (15%), peripheral arterial disease (9%), other/bowel ischemia (6%), and dialysis access (5%) cases. Patients were transferred to another facility in 41% of cases. The most common reasons for violation were specialty refusal/unavailability (30%), inappropriate documentation (29%), misdiagnosis (19%), poor communication (18%), inappropriate triage (14%), failure to obtain diagnostic labs or imaging (12%), and ancillary/nursing staff (7%) issues. The overall mortality was 19% and 1/3 of involved patients died within the index ED visit. Vascular pathology associated with death were venous-thromboembolic (31.6%), ruptured aortic aneurysm (21.1%), aortic dissection (21.1%), other aortic (10.5%), vascular trauma (10.5%), and bowel ischemia (5%).
CONCLUSIONS: Although the frequency of vascular-related EMTALA violations is low, improvement in areas such as communication, increased awareness of vascular disease among staff, and physician availability are needed to ensure patients receive adequate care. Development of protocols and specialty vascular centers may standardize and improve triage and care.
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