Or. Admin. R. 333-520-0070 - Emergency Department and Emergency Services
(1) As used in this rule:
(a) "Behavioral health assessment " has the
meaning given that term in ORS
743A.012;
(b) "Behavioral health clinician" has the
meaning given that term in ORS
743A.012;
(c) "Behavioral health crisis" has the
meaning given that term in ORS 441.053;
(d) "Caring contacts" mean brief
communications with a patient that starts during care transition such as
discharge or release from treatment, or when a patient misses an appointment or
drops out of treatment, and continues as long as a qualified mental health
professional deems necessary;
(e)
"Lay caregiver" means:
(A) For a patient who
is younger than 14 years of age, a parent or legal guardian of the
patient;
(B) For a patient who is
14 years of age or older, an individual designated by the patient or a parent
or legal guardian of the patient to the extent permitted under ORS
109.640
and
109.675;
or
(C) For a patient who is 14
years or older, and who has not designated a caregiver, an individual to whom a
health care provider may disclose protected health information without a signed
authorization under ORS
192.567;
(2) Hospitals classified
as general and low occupancy acute care shall have an emergency department that
provides emergency services.
(3) A
hospital with an emergency department shall:
(a) Provide emergency services 24 hours a day
including providing immediate life saving intervention, resuscitation, and
stabilization;
(b) Have a licensed
health care practitioner with admitting privileges on-call, 24 hours a day;
(c) Have at least one registered
nurse , appropriately trained to provide emergency care within the emergency
service area;
(d) Have adequate
medical staff and other ancillary personnel necessary to provide emergency care
either present in the emergency service area or available 24 hours a day in
adequate numbers to respond promptly;
(e) Ensure that when surgical, laboratory ,
and X-ray procedures are indicated and ordered, due regard is given to
promptness in carrying them out;
(f) Ensure that it has items for
resuscitation, stabilization, and basic emergency medical care, including
airway equipment and cardiac resuscitation medications and supplies for adults,
children and infants;
(g) Have a
communication system and personnel available 24 hours a day to ensure rapid
communication with ambulances and departments of the hospital including, but
not limited to, X-ray, laboratory, and surgery;
(h) Have a plan for emergency care based on
community needs and on hospital capabilities which sets forth policies,
procedures and protocols for prompt assessment, treatment and transfer of ill
or injured persons, including specifying the response time permissible for
medical staff and other ancillary personnel;
(i) Provide for the prompt transfer of
patients, as necessary, to an appropriate facility in accordance with transfer
agreements, approved trauma system plans, consideration of patient choice, and
consent of the receiving facility ;
(j) Have written transfer agreements for the
care of injured or ill persons if the hospital does not provide the type of
care needed;
(k) Ensure that
personnel are able to provide prompt and appropriate instruction to ambulance
personnel regarding triage, treatment and transportation;
(l) Develop, maintain, and implement current
written policies and procedure that include clearly-defined roles,
responsibilities, and reporting lines for emergency service
personnel;
(n) Establish a committee of the emergency
department staff who shall at least quarterly, review emergency services by
evaluating the quality of emergency medical care given, and engage in ongoing
development, implementation, and follow-up on corrective action plans;
and
(o) Ensure it provides
appropriate training programs for hospital emergency service
personnel.
(4) Effective
December 1, 2018, a hospital shall adopt, maintain and follow written policies
that pertain to the release of a patient from the emergency department who is
being seen for a behavioral health crisis. The policies shall include but are
not limited to:
(a) A requirement to
encourage the patient to designate a lay caregiver and sign an authorization
form in accordance with OAR 333-505-0055(2)(b)(A);
(b) A requirement to conduct a behavioral
health assessment by a behavioral health clinician;
(c) A requirement to conduct a best practices
suicide risk assessment , and if indicated develop a safety plan and lethal
means counseling with the patient and the designated caregiver;
(d) A requirement to assess the long-term
needs of the patient which includes, but is not limited to:
(A) The patient's need for community based
services;
(B) The patient's
capacity for self-care; and
(C) To
the extent practicable, whether the patient can be properly cared for in the
place where the patient resided at the time the patient presented at the
emergency department ;
(e)
A process to coordinate care through the deliberate organization of patient
care activities which includes one or more of the following: notification to a
patient's primary care provider , referral to other provider including peer
support as defined in OAR 333-505-0055, follow-up after release from the
emergency department , or creation and transmission of a plan of care with the
patient and other provider;
(f) A
process for case management that includes a systematic assessment of the
patient's medical, functional and psychosocial needs and may include an
inventory of resources and supports recommended by a behavioral health
clinician, indicated by a behavioral health assessment , and agreed upon by the
patient;
(g) A process to arrange
caring contacts between a patient and a provider or follow-up services for the
patient in order to successfully transition a patient to outpatient services.
For purposes of this subsection "provider " includes a behavioral health
clinician, peer support specialist, peer wellness specialist, family support
specialist or youth support specialist as those terms are defined in ORS
414.025
and who are certified in accordance with OAR chapter 410, division 180.
(A) A hospital may facilitate caring contacts
through contracts with a qualified community-based behavioral health provider,
or through a suicide prevention hotline;
(B) Caring contacts may be conducted in
person , via telemedicine or by phone;
(C) Caring contacts if possible must be
attempted within 48 hours of release if a behavioral health clinician has
determined a patient has attempted suicide or experienced suicidal ideation;
and
(h) A process to
schedule a follow-up appointment with a clinician for not later than seven
calendar days of release. If a follow-up appointment cannot be scheduled within
seven days, the hospital must document why.
(5) Policies developed in accordance with
section (4) of this rule shall comply with OAR 333-505-0055 subsection (2)(a)
paragraphs (B) through (D) and section (3).
(6) If a hospital is also designated or
categorized as a trauma hospital under ORS
431.607
through
431.671,
the hospital shall:
(a) Comply with the
applicable provisions in OAR chapter 333, division 200 through 205;
(b) Report trauma data to the State Trauma
Registry in accordance with the requirements of the Division ; and
(c) Fully cooperate with the approved area
trauma system plan.
(7)
An officer or employee of a general or low occupancy acute care hospital
licensed by the Division may not deny a person an appropriate medical screening
examination needed to determine whether the person is in need of emergency
medical services if the screening is within the capability of the hospital ,
including ancillary services routinely available to the emergency
department.
(8) An officer or
employee of any hospital licensed by the Division may not deny services to a
person diagnosed by a physician as being in need of emergency medical services
because the person is unable to establish the ability to pay for the services
if those emergency medical services are customarily provided at the
hospital .
(9) A mental or
psychiatric hospital shall assess and provide initial treatment to a person
that presents to the hospital with an emergency medical condition, as that term
is defined in
42
CFR 489.24. The hospital shall admit the
person if the emergency medical condition falls within the specialty services
provided by the hospital under OAR chapter 333, division 525.
Notes
Statutory/Other
Statutes/Other Implemented: ORS 441.025 & 441.053
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