1. What is a “floor emergency?”
A floor emergency occurs when an admitted patient is determined to have an emergent condition by the floor nurse or other provider assigned to the patient’s floor, and no other physician is available to provide emergency care for the patient.
2. What responsibility does the emergency physician have to go to the patient’s room and manage the patient’s emergency?
An emergency physician’s principal legal and ethical responsibility is to patients who present to be seen and treated in the emergency department. According to ACEP:
3. Does the hospital need a policy or protection for the emergency physician to “abandon” the emergency department to go to the floor and treat and inpatient?
According to ACEP policy, hospital medical emergency response plans and teams should be organized in a manner that is not reliant upon an emergency physician unless the emergency department and its patients' medical needs can be safely provided for at all times. Emergency physicians shall have adequate legal protection when responding to in-hospital emergencies outside the emergency department. Hospital policy and procedures should clearly delineate that once an admitting physician has accepted a patient, that admitting physician has assumed responsibility for the patient.
4. What happens when an ED patient AND an admitted patient both have an emergency and the ED physician is the only physician in the hospital?
The emergency physician and staff would need to first assure their actions are consistent with hospital policy. In many hospitals, Hospitalists are in the hospital 24/7 and would be the first called to the patient’s bedside. The hospitalist might stabilize the inpatient allowing the emergency physician to either remain in the ED or go to the floor after the ED emergency has passed. As is referenced in Emergency Physicians’ Patient Care Responsibilities Outside of the Emergency Department, “The emergency physician's principal legal and ethical responsibility is to patients who present to be seen and treated in the emergency department.” With regard to responsibility for inpatients, “Hospital medical emergency response plans and teams should be organized in a manner that is not reliant upon an emergency physician unless the emergency department and its patients' medical needs can be safely provided for at all times.”
5. How do I bill for the emergency physician who provides a service to an admitted patient?
Although the emergency physician is providing a valuable service to the inpatient as a provider assigned to the emergency department, billing for Evaluation and Management services out of the emergency generally presents a challenge. However, when the emergency physician performs a billable procedure, such as intubation, Critical Care, Central Line, Epistaxis Control, or CPR, those services can be billed. As patients are inpatients and not ED or outpatients, the ED and outpatient codes would not apply.
Updated January 2023
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