N.J. Admin. Code § 8:43G-12.7

Current through Register Vol. 56, No. 12, June 17, 2024

Section 8:43G-12.7 - Emergency department patient services

(a) When an individual comes to the emergency department requesting examination or treatment for a medical condition, or if a request is made on the individual's behalf, clinical priority for treatment shall be assigned by a registered professional nurse or qualified medical personnel.

(b) Treatment for life-threatening emergencies shall be initiated immediately.

(c) If an individual comes to the emergency department requesting examination or treatment for a medical condition, or if a request is made on the individual's behalf, the hospital shall provide for an appropriate medical screening examination performed by qualified medical personnel. Medical screening may be provided in the emergency department or urgent care clinic or area accessible to the emergency department and on hospital grounds.

1. Qualified medical personnel shall perform all medical screenings designed to identify patients clinically suspected of presenting with a stroke.

2. If the hospital is a designated primary or comprehensive stroke center, whenever a clinical suspicion of stroke exists, the stroke team shall further evaluate the patient consistent with the stroke treatment protocols established by the hospital as required for designation in accordance with N.J.A.C. 8:43G-7A.

(d) If it is determined that an emergency medical condition exists, the patient must be evaluated by a physician and provided with such medical treatment as is necessary to assure that the condition has been stabilized, except as provided in (e) below.

(e) If a patient has an emergency medical condition which has not been stabilized, the hospital shall not transfer the patient unless:

1. The patient (or a legally responsible person acting on the patient's behalf), after being informed of the hospital's obligations under this section and of the risk of transfer, in writing requests transfer to another medical facility; or

2. A physician has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the patient and, in the case of labor, to the unborn child, from effecting the transfer. This certification shall include a summary of the risks and benefits upon which the certification is based.

(f) If it is determined that an emergency medical condition does not exist, the patient shall either be treated in the emergency department or shall be referred to an appropriate health care facility or provider; and the patient shall be discharged in accordance with (n) below.

(g) No patient who comes to the emergency department shall be discharged to home or another facility without being seen and evaluated by qualified medical personnel. This evaluation shall occur within four hours of the patient's coming to the emergency department.

(h) The hospital shall implement a protocol for meeting the needs of patients in a timely manner, such as augmenting staff and notifying or diverting ambulances when a specified volume of patients in the emergency department is reached, or patient waiting time before initial evaluation by qualified medical personnel exceeds four hours.

(i) The emergency department shall have a written protocol for the care and disposition of patients who stay in the department for protracted periods of time, for example, in awaiting inpatient beds. This protocol shall address areas such as patient monitoring, patient privacy, provision for family members or significant others, and the active seeking of inpatient beds or transfer by emergency department staff.

(j) A patient shall be transferred from the emergency department to the in-patient service of the hospital, to a facility that provides care unavailable at the hospital, or discharged to home no more than 12 hours after the patient is initially treated on an emergency basis or is stabilized. Exceptions to the 12 hour requirement shall pertain when:

1. Test results are pending and will be used to determine discharge action;

2. The patient is under clinical observation; or

3. The patient is waiting after transport has been summoned.

(k) The hospital shall maintain documentation in all cases in which patients are retained for more than 12 hours in the emergency department.

(l) No patient for whom inpatient admission is required shall be held under clinical observation in the emergency department for more than eight hours if a bed is available in an inpatient unit that has the correct monitoring equipment or can meet the needs of the patient.

(m) A registry of all individuals who come to the emergency department shall be maintained that includes the patient name and a least:

1. Medical record number;

2. Date and time arrived. After December 20, 2000, the names of the ambulance provider and mobile intensive care unit provider, if applicable, shall be entered in the registry;

3. Time discharged;

4. The name(s) of qualified medical personnel who provided the emergency medical screening examination;

5. The name(s) of treating qualified medical personnel;

6. Chief complaint and/or medical diagnosis; and

7. Disposition of the patient.

(n) Upon discharge from the emergency department following a medical screening examination and/or treatment, the patient or his or her representative shall be given written instructions and an oral explanation of those instructions. Documentation of instructions, the name of the physician who ordered the instructions, the name of the person who gave the oral explanation, and the name of the person receiving the instructions shall be entered legibly in the medical record.

(o) Patients requiring post-discharge care shall be referred after clinical evaluation to needed health care or health-related resources. The hospital shall provide assistance, such as referral to the social work department, to a patient requiring assistance in obtaining needed services.

(p) A patient shall be transferred to another health care facility only for a valid medical reason or by patient choice. The sending emergency department shall receive approval from a physician and the receiving health care facility before transferring the patient. Documentation for the transfer shall be sent with the patient, with a copy or summary maintained by the transferring hospital. This documentation shall include at least:

1. Informed consent of the patient or responsible individual, if possible;

2. Reason for transfer;

3. Signature of the physician who ordered the transfer;

4. Condition of the patient upon transfer;

5. Patient information collected by the sending emergency department, including x-ray films or written interpretation by a radiologist; and

6. Name of the contact person at the receiving hospital.

(q) Documentation of a patient's transfer sent by the transferring hospital shall be a permanent part of the patient's medical record at the receiving hospital.

(r) A medical record shall be established and maintained for each patient treated in the emergency department and include at least:

1. Mode, date and time of arrival. After (one year after the adoption of these rules), the names of the ambulance provider and mobile intensive care unit provider, if applicable, and copies of all available prehospital care records shall be entered in the patient's emergency department medical record;

2. Allergies, including allergy to latex;

3. Medications used before coming to the emergency department;

4. Immunizations when relevant;

5. Timed vital signs;

6. Chief complaint;

7. Physician assessment;

8. Nursing assessment;

9. Treatment rendered, signed by the person who rendered the treatment;

10. Medications prescribed and administered while in the emergency department signed by the person who prescribed and the person who administered the medications;

11. Discharge instructions;

12. Last menstrual period, if relevant;

13. Whether the patient visited the emergency department within the previous 72 hours;

14. Age and sex of the patient; and

15. Transfer information, such as destination facility and reason for transfer.

(s) Deceased patients shall be removed from rooms occupied by other patients, when possible, or shall be curtained off. The deceased shall be transported in the hospital and removed from the hospital in a dignified manner.

(t) The emergency department staff shall conform with hospital policies and procedures for complying with applicable statutes and protocols to report child abuse, sexual abuse, and abuse of elderly or disabled adults, specified communicable disease, rabies, poisonings, and unattended or suspicious deaths.

(u) The emergency department shall be prepared to communicate and shall communicate with emergency medical services regarding patients about to arrive by emergency vehicles. The department shall be prepared to receive such patients when they arrive.

(v) The phone number of the designated regional or Statewide New Jersey Poison Information and Education System (800) 222-1222 shall be posted in the emergency department.

(w) Radiology services for emergency needs shall be available to the emergency department 24 hours a day.

(x) Clinical laboratory services for emergency needs shall be available to the emergency department 24 hours a day.

(y) The emergency department shall have access to and utilize a record of hospital employees, medical staff members, and volunteers who can provide interpretive services to patients as required at 8:43G-5.5(c).

(z) Security personnel shall be available to the emergency department when needed.

N.J. Admin. Code § 8:43G-12.7

Amended by 50 N.J.R. 552(b), effective 1/16/2018