December 6, 2007

JUST A REMINDER TO PROFESSIONAL STAFF MEMBERS
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.

DAYTON CHILDREN’S ADDRESSES VENDOR POLICIES 
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. 

PARKING GARAGE OPEN
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.

PROFESSIONAL STAFF PARKING
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.