Add EMTALA-based language to privileging forms
Language that addresses the EMTALA requirements to assess, stabilize, and determine a patient’s condition can be added to your delineation of privilege forms as applicable to each specialty for which the medical executive committee (MEC) has established call coverage 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.”
For organizations that utilize the core privileging methodology, this statement should be included in the initial description of the core. Physicians who hold privileges in their respective specialty areas but may not qualify for the full set of core privileges should be competent to assess and stabilize the patient and then transfer care as appropriate. For example, an orthopedist who specializes in hips or knees is competent to assess a patient with a dislocated shoulder and make the determination as to where to transfer the care of the patient as appropriate.
For organizations that utilize laundry list privileges, the same language could be inserted as a matter of policy for any practitioners who are requesting privileges in their areas of practice in accordance with the MEC’s established requirements for call coverage by specialty.
The problem of ED call coverage is not easily fixed and requires thoughtful discussion and negotiation between all parties involved (e.g., physicians, senior administration, and medical staff leadership). However, organizations can provide guidance and clarification within their privileging forms by adding language that addresses what is required by EMTALA, as noted above.
Call coverage aside, department chairs and credentials committees must use caution when evaluating and recommending privileges for, as an example, the orthopedist who chooses to focus on hip and knee replacements in his or her private practice but takes call for general orthopedics at the hospital. The competency equation is still applicable. The competency equation puts the burden on the applicant to prove not only that he or she has provided a service or procedure (volume) but also that he or she has done it well (outcomes). When your organization establishes volumes as one of the qualifications for privileges, it should require physicians to perform a minimum number of procedures to maintain their skills. The push to link competence to clinical privileges is why it is so important to accurately delineate or describe the clinical privileges being requested and granted.