Ballard Dustin W, Derlet Robert W, Rich Ben A, Lowe Robert A
Department of Emergency Medicine, Kaiser Permanente San Rafael, CA 94903, USA.
Am J Emerg Med. 2006 Mar;24(2):197-205. doi: 10.1016/j.ajem.2005.09.003.
To determine to what extent cases sanctioned under the Emergency Medical Treatment and Active Labor Act (EMTALA) reflect willful refusal of screening or stabilization.
The Centers for Medicare and Medicaid Services were petitioned for all confirmed EMTALA citations from year 2000. Each citation was classified into one of three categories: (1) willful refusal to perform a screening exam or to stabilize; (2) possible refusal to screen or stabilize; or (3) no evidence of refusal to screen or stabilize. Citations were reviewed to determine the presence of 10 other characteristics. Three investigators independently reviewed a subset of data to verify acceptable inter-rater reliability.
We received 157 (53%) of the 294 records requested. Of the 131 involving ED personnel, 44 (34%) demonstrated willful refusal of screening or stabilization. Thirty-two (24%) were possible refusals of service, and 55 (42%) contained no evidence of refusal.
Emergency department willful refusal of screening and stabilization still occurs despite enforcement of EMTALA.
确定根据《紧急医疗救治与积极分娩法案》（EMTALA）受到制裁的案例在多大程度上反映了故意拒绝筛查或稳定治疗的情况。
向医疗保险和医疗补助服务中心申请了2000年以来所有已确认的EMTALA违规记录。每条记录被分为三类之一：（1）故意拒绝进行筛查检查或稳定治疗；（2）可能拒绝筛查或稳定治疗；或（3）无拒绝筛查或稳定治疗的证据。对记录进行审查以确定是否存在其他10个特征。三名研究人员独立审查了一部分数据，以验证评分者间的可接受信度。
我们收到了所请求的294份记录中的157份（53%）。在涉及急诊室人员的131份记录中，44份（34%）显示故意拒绝筛查或稳定治疗。32份（24%）可能存在服务拒绝情况，55份（42%）没有拒绝的证据。
尽管实施了EMTALA，但急诊科故意拒绝筛查和稳定治疗的情况仍然存在。
Zotero 插件