In some medical institutions, due to limited physician coverage, the emergency physician is required to respond to various in-hospital (out-of-ED) situations. This is particularly true during evenings, nights, weekends, and holidays.
In those institutions with single emergency physician coverage, responding to such situations leaves the ED without direct physician coverage. This then deprives ED patients of physician-supervised medical care, places undue stress and liability on ED nursing staff, and prevents the continuity of other physician-related ancillary tasks (e.g.; prehospital medical command, etc.). In addition, requiring the emergency physician to respond to situations involving gravely ill in-house patients potentially imposes an enormous burden of liability on the EP.
Nonetheless, the reality of life threatening situations, where no other physician is available, is such that EP response is an ethical and professional consideration.
It is the position of The American Academy of Emergency Medicine that:
- It is in the best interest of patients within the emergency department that a board-certified emergency physician be physically present within the confines of the ED to ensure optimal care;
- The emergency physician's first responsibility is to those patients present in the emergency department who are undiagnosed, unstable or potentially unstable as well as to subsequent seriously ill or injured E.D. patients who may arrive without any notice;
- Under no circumstance can a physician, while working in the ED, be considered to have a legally binding patient-physician relationship with a non-ED patient requiring the physician's response. An emergency physician responding to aid a hospitalized patient does so as a Good Samaritan;
- Unstable or critically ill in-patients are best cared for by their attending physicians who have an ongoing knowledge of the patients condition and hospital course;
- When asked to attend to a patient outside the emergency department, an emergency physician must be allowed to decline at his (her) discretion given the demands of patient care in the emergency department.
- Emergency physicians should only respond to life threatening emergencies and only when there are no other personnel to do so;
- Emergency physicians should be considered first physician responders during an in-patient emergency. As such, they should not be required to provide definitive care for patients who are already attended by other physicians. Hospitals and medical staffs must ensure that other qualified medical personnel (preferably the patient's attending physician) respond quickly to relieve the emergency physician and continue patient care;
- Hospitals should indemnify emergency physicians accused of negligence while providing assistance to non-ED hospital patients.
Published: 2/20/03