DEPARTMENT: Risk & Insurance / POLICY DESCRIPTION: EMTALA - Stabilization
PAGE:1 of 3 / REPLACES POLICY DATED:
APPROVED: November 12, 1998 / RETIRED:
EFFECTIVE DATE: January 1, 1999 / REFERENCE NUMBER: RI.002
SCOPE: All Company facilities including hospitals and any entities operating under the hospital’s Medicare Provider Number including, but not limited to, the following:
All Clinical Departments Administration
Ancillary Services Quality Management
Admitting/Registration Risk Management
Employed Physicians Emergency Department
Hospital owned Medical Office Buildings Urgent Care Centers/clinics
Hospital owned emergency vehicles Ambulatory Care Facilities
Health Information Management Business Office
Nursing
PURPOSE: To ensure that all patients determined to have an emergency medical condition shall be stabilized as required under EMTALA.
POLICY: Patients being transferred or discharged will be stabilized as required under EMTALA.
Some states have separate emergency services laws that may apply additional legal requirements to the Medical Screening Examination, diagnostic testing, or stabilizing emergency medical treatment. Consult with your Operations Counsel to identify and comply with any such additional legal mandates.
PROCEDURE: Please refer to the EMTALA - Medical Screening Policy, RI.001, for a complete list of definitions pertaining to this policy.
1.Stabilization, with respect to an emergency medical condition, means to either provide such medical treatment of the condition necessary to assure within reasonable medical probability that no material deterioration of the condition is likely to result from, or occur during, the transfer of the individual from a facility, or that the woman has delivered the child and the placenta.
2.A patient will be deemed stabilized if the treating physician attending to the patient in the emergency department/hospital has determined within reasonable clinical confidence that the emergency medical condition has resolved.
3.For patients whose emergency medical condition has not been resolved, the determination of whether they are medically stable may occur in one of the following two circumstances:
a.Stable For Transfer – A patient is stable for transfer from one facility to a second facility if the treating physician has determined within reasonable clinical confidence that the patient is expected to leave the hospital and be received at the second facility with no material deterioration in his/her medical condition and the treating physician reasonably believes that the receiving facility has the capability to manage the patient’s medical condition and any reasonably foreseeable complication of that condition.
i. For purposes of transferring a patient with a psychiatric condition between facilities, the patient is considered to be stable when he/she is protected and prevented from injuring himself/herself or others.
ii. If there is a disagreement between the treating physician and an off-site physician (e.g., a physician at the receiving facility or the patient’s primary care physician if not physically present at the first facility) about whether the patient is stable for transfer, the medical judgment of the treating physician usually takes precedence over that of the off-site physician.
b.Stable For Discharge – A patient is considered stable for discharge when, within reasonable clinical confidence, it is determined that the patient has reached the point where his/her continued care, including diagnostic workup and/or treatment, could be reasonably performed as an outpatient or later as an inpatient, provided the patient is given a plan for appropriate follow-up care with the discharge instructions.
For purposes of discharging a patient with a psychiatric condition, the patient is
Considered to be stable when he/she is no longer considered to be a threat to him/herself
or to others.
4.Neither stable for discharge or stable for transfer requires the final resolution of the emergency medical condition.
5. Hospitals may not circumvent these requirements by admitting the patient with an emergency medical condition to another department of the hospital and then discharging him/her prior to stabilization.
6. These requirements apply to all areas of the hospital, including the emergency department, intensive care, obstetrics and other areas that treat patients with emergency medical conditions.
  1. The physician certification that the benefits reasonably expected from the provision of appropriate medical treatment at another facility outweigh the risk of the transfer (see EMTALA-Transfer Policy, RI.003) is not required for transfers of individuals who no longer have an emergency medical condition, unless otherwise required by state law. A stabilized patient may be transferred upon request or pursuant to pre-arranged transfers/treatment plans of state, county or other entities if the following conditions are met:
  • Documentation of patient stabilization has been prepared by a physician or a qualified medical person in consultation with a physician (physician’s counter-signature is required on documentation);
  • the transferring hospital should document its communication with the receiving hospital, including the date and time of the transfer request and the name of the person accepting the transfer;
  • if the transfer is requested by the patient, the request must be in writing and must indicate the reason(s) for the request as well as indicate that the patient is aware of the risks and benefits of the transfer;
  • the patient has been informed of the hospital’s obligation to provide an emergency medical screening and the necessary stabilizing treatment;
  • the receiving facility: a) has available space and qualified personnel for the treatment of the individual, and b) has agreed to accept the transfer of the individual and to provide appropriate medical treatment; and
  • the individual agrees to the transfer.
  1. A patient whose condition has not been stabilized may be transferred (see EMTALA - Transfer Policy, RI.003) to another facility if:
  • The individual, after being informed of the risks and the hospital’s obligations, requests a transfer; or
  • A physician has signed a certificate that the benefits of the transfer to another medical facility outweigh the risks to the individual.

REFERENCES:
Social Security Act, Section 1867, 42 U.S.C. 1395dd, Examination and Treatment for Emergency
Medical Conditions and Women In Labor
HCFA Site Review Guidelines, State Operations Manual
42 Federal Register 489.24(c), Special Responsibilities of Medicare Hospitals in Emergency Cases
EMTALA Medical Screening Policy, RI.001
EMTALA Transfer Policy, RI.003
EMTALA Signage Policy, RI.004
EMTALA Central Log Policy, RI.005
EMTALA Duty to Accept Policy, RI.006
EMTALA Provision of On-Call Coverage Policy, RI.007