The American College of Osteopathic Emergency Physicians (ACOEP) developed the Practice Management Guidelines as a tool to assist members in their practice of Emergency Medicine.
Policy 1 - THE ROLE OF PHYSICIAN EXTENDERS IN EMERGENCY DEPARTMENTS
Physician extenders, including but not limited to nurse practitioners, physician assistants, paramedics, and emergency medical technicians, provide medical care in a variety of acute and non-acute settings.
To assist its members, the American College of Osteopathic Emergency Physicians (ACOEP) has developed the following guidelines for the role of physician extenders (PE's) in an Emergency Department. These guidelines should not be interpreted as mandatory by legislative, judicial, or regulatory bodies, or by the American College of Osteopathic Emergency Physicians.
- Physician extenders should only be placed in clinical situations where they will supplement, but not replace, the medical expertise and patient care provided by emergency medicine physicians.
- The emergency medicine physician must evaluate the care of each patient and assume the ultimate responsibility for patient care.
- The scope of a PE's practice must be clearly delineated and should minimally include:
- the number of PE's that can be supervised by one (1) emergency medicine physician.
- a description of the role and responsibility of a PE.
- a list of conditions that the PE is credentialed to treat.
- a list of conditions that require the immediate consultation of the emergency medicine physician.
- a list of procedures the PE many perform.
- Physician extenders should have specific experience or specialty training in emergency medicine.
- Physician extenders should maintain appropriate continuing medical education in emergency medicine.
- Physician extenders must participate in the quality assessment activities of an emergency department.
- Credentialing procedures must be specifically stated and should be similar to those required of other allied health professionals.
- All PE's should be nationally certified or meet the requirements of the state or federal jurisdiction in which they practice.
return to top...>
Policy 2 - THE ROLE OF EMERGENCY PHYSICIANS IN PREVENTIVE MEDICINE
The American College of Osteopathic Emergency Physicians (ACOEP) recognizes the extreme importance of the role that the emergency physician plays in the treatment of disease and injury that is the direct result of maladaptive lifestyles and behaviors. The ACOEP also recognized the critical role the emergency physician can play in the prevention of disease and violence.
The ACOEP has developed the following suggestions to assist the practicing emergency medicine physician in their practice and research of preventive emergency medicine.
- The emergency medicine physician (EMP) should be actively involved in activities and educational programs that detail the inherent risk in alcohol consumption and vehicle driving.
- The EMP should be actively involved in activities and educational programs that heighten the public's awareness of the physical effects of alcohol and other abused drugs.
- The EMP should be actively involved in local educational programs that educate children and adolescents on the inherent dangers of alcohol and abused drugs.
- The EMP should be involved in the education of senior citizens in regard to the interactions of alcohol and their medications.
- The EMP should be actively involved in educational programs and activities that deal with issues of family violence.
- The EMP should be actively involved in educational programs and activities that address local youth and gang violence.
- The EMP must report suspected occurrences of child, spousal, or elder abuse to the appropriate authorities within the State statutes in which the EMP practices.
- The EMP should be involved with programs that educate the public in regards to behavioral patterns that can result in the prevention of traumatic injury, such as seat-belts, motorcycle and bicycle helmets, and child car seats.
- The EMP should be involved in programs that ensure the adequate and complete immunization of all children.
- The EMP should be actively involved in educational programs that heighten the public's awareness to the long-term physical effects of tobacco abuse.
- The EMP should be involved in the local and national legislative movements that protect a patient from the undue effects of societal violence, alcohol and drug abuse and recreational injuries.
- The EMP should be actively involved in promoting wellness by choice behavior.
return to top...>
Policy 3 - RAPID-SEQUENCE INTUBATION
Rapid-sequence intubation (RSI) is a critical adjunct to the control and management of the airway in the emergency department. RSI is a fundamental skill for the practicing emergency medicine physician.
The American College of Osteopathic Emergency Physicians (ACOEP) recognizes the necessity that the practicing emergency medicine physician possess the requisite skills and training in performing rapid sequence intubation.
The ACOEP has connoted the following credentialing criteria and practice management concepts in regards to rapid-sequence intubation.
- Physicians credentialed to perform rapid-sequence intubation (RSI) should be board certified or board eligible by the AOBEM or ABEM.
- Physicians credentials to perform RSI should possess training in surgical and non-surgical alternatives in airway management.
- The appropriate sedative and paralytic agents should be immediately available in the ED for emergency medicine physicians credentialed in RSI.
- The appropriate quality assessment programs should specifically address RSI.
return to top...>
Policy 4 - EMERGENCY MEDICINE PRACTICE CHARACTERISTICS
The American College of Osteopathic Emergency Physicians (ACOEP), via survey of its general membership, has determined an ideal environment in which to practice emergency medicine. This practice environment specifically addresses the membership concerns regarding practice autonomy, practice longevity, practice security, equality in financial reimbursement, standards in ED staffing, and due process.
In order to assist its members in identifying these specific characteristics, the ACOEP has enumerated the following traits of the preferred practice setting.
The preferred practice setting:
- Is one of democratic partnership.
- Would prohibit physician or group termination without cause.
- Would prohibit restrictive covenant clauses.
- Would include contractual language ensuring due process or peer review prior to physician or group termination.
- Would include contractual language prohibiting economic credentialing.
- Would include 24-hour staffing of an emergency department by an AOBEM/ABEM board certified/board eligible emergency medicine physician.
- Would include practicing board certified emergency medicine physicians who participate in the recertification process at appropriate intervals.
return to top...>
Policy 5 - EMERGENCY DEPARTMENT ULTRASOUND
Examination by ultrasound should be available in a timely 24-hour basis for all emergency patients.
The emergency physician who has completed appropriate ultrasound training is ideally suited to perform goal-directed ultrasound examinations. The immediate information that can be obtained through these studies may expedite the care and disposition of acutely ill or injured patients.
To assist its members in the description of ultrasound use by emergency physicians, the American College of Osteopathic Emergency Physicians endorses the following principles:
- Emergency Department ultrasound is within the scope or practice of the emergency physician.
- Emergency physicians utilizing ultrasound-imaging technology should demonstrate appropriate training and experience in order to perform and interpret these studies.
- Clinical indications for ultrasonographic examination by an emergency physician may include, but not be limited to:
- Abdominal aneurysm
- Traumatic hemoperitoneum
- Ectopic pregnancy
- Pericardial tamponade
- Biliary tract evaluation
- Renal tract evaluation
- Central line placement
- Foreign body identification
return to top...>
Policy 6 - EMERGENCY DEPARTMENT TELEPHONE ADVICE
(Approved, April 2001)
The public often views the emergency department as a source of medical information.
It is recognized that despite the inadequacies in the appropriate evaluation of patients via a telephone, the expectations of the public continue to exist in regards to the availability of medical information from the emergency department via telephone.
It is the recommendation of the American College of Osteopathic Emergency Physicians that emergency physicians do not provide routine medical advice via the telephone.
When hospitals decide to provide telephone medical advice, the American College of Osteopathic Emergency Physicians recommends to its members the following:
- Individuals describing potential life or limb threatening emergencies should be instructed to call 9-1-1 or seek emergency care.
- Hospitals that choose to serve as a medical advice line should ensure the following:
- Individuals providing the service should receive training specific to the service provided.
- Individuals providing the service should be covered with appropriate malpractice insurance
- Assessment and treatment should follow algorithms that conform to recognized practice standards of emergency medicine.
- Complete documentation of each call.
- A CQI process should be in place.
- Emergency Departments should have formalized procedures on how medical advice via the telephone is provided.
return to top...>