Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass.
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass.
J Vasc Surg. 2021 Aug;74(2):599-604.e1. doi: 10.1016/j.jvs.2020.12.110. Epub 2021 Feb 4.
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 receive medical care regardless of means. Violations are reported to the Centers for Medicare and Medicaid Services and can result in significant financial penalties. Our objective was to assess all available EMTALA violations for vascular-related issues.
EMTALA violations in the Centers for Medicare and Medicaid Services publicly available hospital violations database from 2011 to 2018 were evaluated for vascular-related issues. Details recorded were case type, hospital type, hospital region, reasons for violation, disposition, and mortality.
There were 7001 patients identified with any EMTALA violation and 98 (1.4%) were deemed vascular related. The majority (82.7%) of EMTALA violations occurred at urban/suburban hospitals. Based on the Association of American Medical Colleges United States region, vascular-related EMTALA violations occurred in the Northeast (7.1%), Southern (56.1%), Central (18.4%), and Western (18.4%) United States. Case types included cerebrovascular (28.6%), aortic related (22.4%; which consisted of ruptured aortic aneurysms [8.2%], aortic dissection [11.2%], and other aortic [3.1%]), vascular trauma (15.3%), venous-thromboembolic (15.3%), peripheral arterial disease (9.2%), dialysis access (5.1%), bowel ischemia (3.1%), and other (1%) cases. Patients were transferred to another facility in 41.8% of cases. The most common reasons for violation were specialty refusal or unavailability (30.6%), inappropriate documentation (29.6%), misdiagnosis (18.4%), poor communication (17.3%), inappropriate triage (13.3%), failure to obtain diagnostic laboratory tests or imaging (12.2%), and ancillary or nursing staff issues (7.1%). The overall mortality was 19.4% and 31.6% died during the index emergency department visit. Vascular conditions associated with death were venous thromboembolism (31.6%), ruptured aortic aneurysm (21.1%), aortic dissection (21.1%), other aortic causes (10.5%), vascular trauma (10.5%), and bowel ischemia (5.3%).
Although the frequency of vascular-related EMTALA violations was low, improvements in communication, awareness of vascular disease among staff, specialty staffing, and the development of referral networks and processes are needed to ensure that patients receive adequate care and that institutions are not placed at undue risk.
《紧急医疗治疗与劳动法》（EMTALA）是 1986 年制定的一项联邦法律，旨在确保到急诊科就诊的患者无论支付能力如何都能获得医疗护理。违规行为会报告给联邦医疗保险和医疗补助服务中心，并可能导致重大的财务处罚。我们的目的是评估所有可用的 EMTALA 违规行为中与血管相关的问题。
从 2011 年至 2018 年，评估了联邦医疗保险和医疗补助服务中心公开的 EMTALA 违规行为医院违规行为数据库中与血管相关的问题。记录的详细信息包括病例类型、医院类型、医院区域、违规原因、处置和死亡率。
确定了 7001 例 EMTALA 违规患者，其中 98 例（1.4%）被认为与血管相关。大多数（82.7%）EMTALA 违规发生在城市/郊区医院。根据美国医学协会的美国地区划分，与血管相关的 EMTALA 违规发生在美国东北部（7.1%）、南部（56.1%）、中部（18.4%）和西部（18.4%）。病例类型包括脑血管疾病（28.6%）、主动脉相关疾病（22.4%；其中包括破裂的主动脉瘤[8.2%]、主动脉夹层[11.2%]和其他主动脉[3.1%]）、血管创伤（15.3%）、静脉血栓栓塞（15.3%）、外周动脉疾病（9.2%）、透析通路（5.1%）、肠缺血（3.1%）和其他（1%）病例。在 41.8%的病例中，患者被转往其他医疗机构。违规的最常见原因是专科拒绝或无法提供服务（30.6%）、不适当的记录（29.6%）、误诊（18.4%）、沟通不良（17.3%）、分诊不当（13.3%）、未能获得诊断性实验室检查或影像学检查（12.2%）以及辅助或护理人员问题（7.1%）。总体死亡率为 19.4%，31.6%的患者在急诊科就诊期间死亡。与死亡相关的血管疾病包括静脉血栓栓塞症（31.6%）、破裂的主动脉瘤（21.1%）、主动脉夹层（21.1%）、其他主动脉病因（10.5%）、血管创伤（10.5%）和肠缺血（5.3%）。
尽管与血管相关的 EMTALA 违规频率较低，但需要改善沟通、提高员工对血管疾病的认识、增加专科人员配备，并制定转诊网络和流程，以确保患者得到充分的治疗，并使机构免受不必要的风险。
