6. 什麼是急診醫學？
• FEM 1991：
• A field of practice based on the knowledge and skills
required for the prevention, diagnosis and management of
acute and urgent aspects of illness and injury affecting
patients of all age groups with a full spectrum of
undifferentiated physical and behavioral disorders.
• It further encompasses an understanding of the
development of pre-hospital and in-hospital emergency
medical systems and the skills necessary for this
development."
8. Prudent Layperson
審慎一般人
• 1986: Emergency Medical Treatment and Labor Act
(EMTALA)
• 1994: revision to the EMTAMA
• ”Prudent Layperson“ as a standard for evaluating
whether a patient has an emergency condition.
• 1997: Balanced Budget Act
• ”Prudent Layperson”standard
• Medicaid effective in October 1997
• Medicare in May 1998
• 1999: Veterans Millennium Health Care and Benefits
Act
http://www.pugetsound.va.gov/docs/prudentlaypersonfactsheet.pdf
9. Prudent Layperson
• Balanced Budget Act of 1997 (BBA)
• It defines an ”emergency medical condition” as:
• A medical condition manifesting itself by acute symptoms
of sufficient severity (including severe pain) such that a
prudent layperson, who possess an average knowledge of
health and medicine, could reasonably expect the absence of
immediate medical attention to result in placing the health
of the individual (or, with respect to a pregnant woman, the
health of the woman or her unborn child) in serious
jeopardy, serious impairment to bodily functions, or serious
dysfunction of any bodily organ or part.
https://www.medicaid.gov/Federal-Policy-Guidance/downloads/smd040500.pdf
32. The Psychology of Waiting Lines
• S=P-E (Satisfaction, Perception, Expectation)
• Occupied Time Feels Shorter Than Unoccupied Time.
• People want to get started.
• Anxiety makes waits seem longer.
• Uncertain waits are longer than known, finite waits.
• Unexplained waits are longer than explained waits.
• Unfair waits are longer than Equitable waits.
• The more valuation the service, then longer the customer will
wait.
• Solo waits feel longer than group waits
EMTALA: Request for examination or treatment includes: “a request made on his or her behalf. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent layperson observer would believe, based on the individual's appearance or behavior, that the individual needs examination or treatment for a medical condition;”
主要的目的是為了防止pre-authorization
It also recognized that it was in everyone’s best interest, including the insurers, not to dissuade enrollees from seeking and receiving immediate attention in the ED for such symptoms. The cost of managing the long term consequences of delaying treatment of one severe stroke or MI far exceeds the costs of screening and evaluating dozens of patients in the ED whose symptoms do not portend disaster. Never mind the lives otherwise lost.
主要的目的是為了防止pre-authorization
It also recognized that it was in everyone’s best interest, including the insurers, not to dissuade enrollees from seeking and receiving immediate attention in the ED for such symptoms. The cost of managing the long term consequences of delaying treatment of one severe stroke or MI far exceeds the costs of screening and evaluating dozens of patients in the ED whose symptoms do not portend disaster. Never mind the lives otherwise lost.
