What are the responsibilities of emergency medicine physicians?

Responsibilities of Emergency Medicine Physicians

Emergency physicians have a fundamental obligation to provide timely medical screening examinations and stabilizing treatment to all patients presenting to the emergency department, regardless of their ability to pay, while serving as the primary coordinator of multidisciplinary emergency care teams. 1

Core Clinical Responsibilities

Universal Access and Non-Discriminatory Care

• Emergency physicians must provide necessary emergency care to all patients without regard to race, color, creed, gender, nationality, or ability to pay. 1
• All patients requesting care must receive a medical screening examination and necessary stabilizing treatment without unnecessary delay. 1
• This social responsibility is established by public policy through EMTALA, which mandates evaluation and stabilizing treatment for emergency medical conditions. 1

Direct Patient Care While in the Emergency Department

• The emergency physician is responsible for patient care only while the patient is physically present in the emergency department under their direct care. 1
• Each patient must have a clearly identified physician responsible for their care, with any transfer of responsibility clearly communicated to the patient, family, staff, and documented in the medical record. 1
• Emergency physicians manage the acute deterioration and pathophysiology of any life or limb threat, prioritizing the most serious illness first to protect against morbid complications. 2

Resource Stewardship

• Emergency physicians must act as responsible stewards of health care resources entrusted to them. 1
• They must make careful judgments about appropriate resource allocation to maximize benefits and minimize burdens. 1

Coordination and Communication Responsibilities

Multidisciplinary Team Leadership

• Emergency physicians assume primary responsibility for coordinating the efforts of nurses, emergency medical technicians, and support staff as part of the emergency medicine team effort. 1
• General ethical rules governing these interactions include honesty, respect, appreciation of other perspectives and needs, and an overriding duty to maximize patient benefit. 1

Physician-to-Physician Communication

• Emergency physicians must maintain open channels of communication with other health care providers to optimize patient outcomes. 1
• When practical, they should cooperate with the patient's primary care physician to provide continuity of care that satisfies patient needs and minimizes burdens to other providers. 1
• Emergency physicians should support development and implementation of systems that facilitate communications with primary care providers, consultants, and others involved in patient care. 1

Consultant and On-Call Physician Interactions

• Emergency physicians should strive to treat consultants fairly and make care as efficient as possible. 1
• The choice of consultant may be guided by the preference of both the primary care physician and the patient, or by institutional protocols. 1
• On-call physicians must be available within a reasonable time to provide necessary stabilizing treatment without regard to the patient's ability to pay. 1

Transfer of Care Responsibilities

Clear Delineation of Responsibility

• Transfer of patient care responsibilities between physicians must be orderly, clearly defined, and properly documented. 1
• When a patient is discharged from the emergency department, there must be a clear transfer of responsibility to the admitting or follow-up physician, clearly communicated to the patient when practical. 1

Admission and Transition Orders

• Emergency physicians are responsible for care only while the patient is physically present in the emergency department. 1
• The admitting physician assumes responsibility for patient care after accepting the patient's admission, regardless of the patient's physical location within the hospital. 1
• When compelled to write transition orders, emergency physicians may include essential treatment and assessment parameters required before preparation of suitable admission orders, though the admitting physician retains responsibility for providing inpatient care. 1

Follow-up Care Arrangements

• Follow-up care should be arranged for all patients who require such care. 1
• Requests for consultative services should be made in accordance with the patient's preferences and/or health plan when feasible. 1

Ethical and Legal Obligations

Respect for Patient Autonomy

• Emergency physicians should respect a terminally ill patient's wish to forgo life-prolonging treatment, as expressed in a living will or through a health care agent. 1
• They should honor "Do Not Attempt Resuscitation (DNAR)" orders and other end-of-life orders appropriately executed to express the patient's treatment preferences. 1
• Emergency physicians should understand established criteria for determination of death and assist families in decisions regarding potential organ donation. 1

Truthfulness and Transparency

• Emergency physicians must not overstate their experience, abilities, or those of their colleagues or institution. 1
• They should not overstate potential benefits or success rates of proposed treatment. 1

EMTALA Compliance

• Hospitals and emergency physicians must comply with EMTALA requirements. 1
• Medical screening examinations and stabilizing treatment may require use of ancillary, consultative, or inpatient services within the capability of the hospital and its medical staff. 1
• Physician services provided in response to requests for emergency care should be recognized as emergency services for reimbursement purposes and compensated fairly and equitably. 1

Common Pitfalls to Avoid

• Do not delay medical screening examination or stabilizing treatment based on insurance authorization or ability to pay - this violates EMTALA and core ethical principles. 1
• Do not assume responsibility for inpatient care extends beyond the emergency department - clearly document when care transitions to the admitting physician. 1
• Do not fail to communicate with consultants when immediate intervention is not required - maintain open channels even when urgent action takes precedence. 1
• Emergency physicians serve as first-contact providers who remain the only continuously accessible specialty for patients seeking help in the health care system. 3