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December 16, 2007

      I have had conversations with at least two professional staff members
      about emergency department call responsibilities and consultation
      standards. It is worth reminding everyone of the policies. First, whenever
      Dayton Children’s offers a service, we are obligated to provide emergency
      room coverage for the same service. Thus, if we have an infectious disease
      service, we are obligated to cover emergency department infectious disease
      needs. If we provide ENT services, the same is true. We are obligated to
      evaluate any patient, if requested to do so by the emergency department
      staff, even if the patient has been disengaged from the particular clinic
      in question. The law (EMTALA) requires us to evaluate, stabilize and treat
      any emergency that presents to Dayton Children’s, even if the patient is
      no longer seen in the clinics. Thus we often evaluate, stabilize and
      either admit and treat or transport adults, our own employees and patients
      no longer seen in our clinic. The law is clear. No on-call physician
      should ever refuse to evaluate and treat any emergency department patient.
      To do so is to risk potential fines. 
      Secondly, I am often asked if we have a standard regarding the timely
      completion of consults. The policies and procedures are silent on this
      issue, specifically how quickly a consult must be performed. What is clear
      is that the clinical needs of the patient take precedence. Thus a patient
      in the Almost Home unit might well warrant an emergent consult by any
      service, if the clinical need is real. In contrast, a PICU patient might
      have a consult for “chronic constipation, recurrent otitis media or advise
      for international travel,” deferred to the respective clinic. For the
      record, every service will provide emergent consults regardless of
      location. As usual, physician-to-physician communication is the best plan.
      Questions? Call Tom Murphy, MD, at 937-641-5871.

      A committee of hospital staff and professional staff members met this past
      week to re-evaluate the hospital policy toward vendors (particularly
      pharmaceutical and biomedical/equipment). As you no doubt know, the press
      (both locally and nationally) has recently reported significant episodes
      in which physicians have received substantial financial support from
      pharmaceutical companies. In a Cincinnati case involving a child
      psychiatrist, the physician received at least $180,000 in “fees” from two
      companies over two years. We will keep you posted on the status of this
      work. If you would like to provide any information for the committee to
      consider, please send it to Cindy Asher, Tom Murphy or Greg Huff. 

      The parking garage opened for use by patients on December 3. This provides
      significant new parking options, making it easier for families to access
      Dayton Children’s. At some point in the future, there is the possibility
      that the emergency department lot will be gated and restricted for use by
      emergency department patients. That also would facilitate access.

      We are aware of the challenges accessing the lot outside the laboratory.
      We continue to examine ways to make access easier and safer, including
      proximity readers, changing the actual site of entry or re-engineering the
      angle of the entry. Stay tuned for more information.


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