The hospital shall have written policies for caring for emergency cases, including policies for transferring a patient to an appropriate facility when the patient's medical status indicates the need for emergency care which the hospital cannot provide.
The emergency service shall be directed by personnel who are qualified by training and experience to direct the emergency service and shall be integrated with other services of the hospital.
The policies and procedures governing medical care provided in the emergency service shall be established by and are a continuing responsibility of the medical staff.
Emergency services shall be supervised by a member of the medical staff, and nursing functions shall be the responsibility of a registered nurse.
The hospital's emergency services shall be coordinated with the community's disaster plan, if there is one.
The emergency service shall be provided with the facilities, equipment, drugs, supplies and space needed for prompt diagnosis and emergency treatment.
Facilities for the emergency service shall be separate and independent of the operating room.
The location of the emergency service shall be in close proximity to an exterior entrance of the hospital.
There shall be sufficient medical and nursing personnel available for the emergency service at all times. All medical and nursing personnel assigned to emergency services shall be trained in cardiopulmonary resuscitation before beginning work.
The medical staff shall ensure that qualified members of the medical staff are regularly available at all times for the emergency service, either on duty or on call, and that a physician is responsible for all patients who arrive for treatment in the emergency service.
If unable to reach the patient within 15 minutes, the physician shall provide specific instructions to the emergency staff on duty if emergency measures are necessary. These instructions may take the form of protocols approved by the medical staff or standing orders.
A sufficient number of nurses qualified by training and experience to work in emergency services shall be available to deal with the number and severity of emergency service cases.
Adequate medical records to permit continuity of care after provision of emergency services shall be maintained on all patients. The emergency room patient record shall contain:
Appropriate time notations, including time of the patient's arrival, time of physician notification, time of treatments, including administration of medications, and time of patient discharge or transfer from the service.
Where appropriate, medical records of the emergency service shall be integrated with those of the inpatient and outpatient services.
(e) Emergency services committee.
An emergency services committee composed of physicians, registered nurses and other appropriate hospital staff shall review emergency services and medical records for appropriateness of patient care on at least a quarterly basis. The committee shall make appropriate recommendations to the medical staff and hospital administrative staff based on its findings.
In this subsection, “victim" means a female who alleges or for whom it is alleged that she suffered sexual assault and who, as a result of the sexual assault, presents as a patient at a hospital that provides emergency services.
The department may directly assess a forfeiture for each violation of a requirement under s. 50.375 (2)
, Stats., for care of a victim by a hospital that provides emergency services. The department may assess the forfeitures as follows:
DHS 124.24 Note
Section 50.375 (2)
, Stats., requires a hospital that provides emergency services to a victim to 1) provide to the victim medically and factually accurate and unbiased written and oral information about emergency contraception and its use and efficacy; 2) orally inform the victim of
her option to receive emergency contraception at the hospital,
her option to report the sexual assault to a law enforcement agency,
and any available options for her to receive an examination to gather evidence regarding the sexual assault; and 3) except as specified in s. 50.375 (4)
, Stats., immediately provide to the victim upon her request emergency contraception, in accordance with instructions approved by the federal food and drug administration. If the medication is taken in more than one dosage, the hospital shall provide all subsequent dosages to the victim for later self administration.
DHS 124.24 Note
Section 50.375 (3)
, Stats., requires a hospital that provides emergency care to ensure that each hospital employee who provides care to a victim has available medically and factually accurate and unbiased information about emergency contraception.
If the department determines that a forfeiture should be assessed for a particular violation, the department shall send a notice of assessment to the hospital. The notice shall specify the amount of the forfeiture assessed, the violation and the statute or rule alleged to have been violated, and shall inform the hospital of the right to a hearing under par. (d)
pursuant to s. 50.377 (3)
Pursuant to s. 50.377 (4)
, Stats., all forfeitures shall be paid to the department within 10 days after receipt of a notice of assessment or, if the forfeiture is contested under par. (e)
, within 10 days after receipt of the final decision after exhaustion of administrative review, unless the final decision is appealed and the order is stayed by court order.
Pursuant to s. 50.377 (3)
, Stats., a hospital may contest an assessment of a forfeiture by the department under par. (b)
by sending, within 10 days after receipt of notice under par. (c)
, a written request for a hearing under s. 227.44
, Stats., to the division of hearings and appeals. The administrator of the division may designate a hearing examiner to preside over the case and recommend a decision to the administrator under s. 227.46
, Stats. The decision of the administrator of the division shall be the final administrative decision. The division shall commence the hearing within 30 days after receipt of the request for a hearing and shall issue a final decision within 15 days after the close of the hearing.
DHS 124.24 History
Cr. Register, January, 1988, No. 385
, eff. 2-1-88; CR 09-089
: cr. (3) Register March 2010 No. 651
, eff. 4-1-10.
If the hospital has an organized social work service, that service shall have written policies and procedures. If the hospital does not have an organized social work service, the services of a consultant having the qualifications set out in sub. (2) (a)
shall be secured on a contractual basis. The services performed and recommendations made by the consultant shall be documented in writing.
The social work service shall be directed by a social worker who has:
A master's degree in social work from a graduate school of social work accredited by the council on social work education, and one year of social work experience in a health care setting; or
A bachelor's degree in social work, sociology or psychology, meets the national association of social workers standards of membership and has one year of social work experience in a health care setting.
The social work service staff, in addition to the director, may include social workers, case workers and social work assistants at various levels of social work training and experience.
(c) Numbers of staff.
There shall be a sufficient number of social work service staff to carry out the purpose and functions of the service.
(3) Integration of the service.
The social work service shall be integrated with other services of the hospital, as follows:
Staff shall participate, as appropriate, in ward rounds, medical staff seminars, nursing staff conferences and in conferences with individual physicians and nurses concerned with the care of a particular patient and the patient's family;
Staff shall inform appropriate administrative and professional personnel of the hospital about community programs and developments which may affect the hospital's social work program; and
Staff shall participate in appropriate continuing education and orientation programs for nurses, medical students, interns, residents, physicians and hospital administrative staff, as well as inservice training programs for staff of the service.
Social work service activities shall address the social service needs of patients, their families and others designated by the patient as these relate to the health care and health of the patients.
When appropriate, planning for patient care shall include assessment by the social work staff of the need to provide services to patients, their families and others designated by the patient in order to help them adjust to illness and to plan for needed post-hospital care.
Social work staff shall record their notes on intervention on behalf of a patient, the patient's family and others designated by the patient in the patient's permanent medical record.
More detailed records of the interventions shall be kept by the service to meet the needs of students, training of staff, for research purposes, and to permit review by supervisors or consultants.
The facilities for social work staff shall provide privacy for interviews with patients, their family members and other persons designated by the patients.
DHS 124.25 History
Cr. Register, January, 1988, No. 385
, eff. 2-1-88.
DHS 124.26 Additional requirements for psychiatric hospitals. DHS 124.26(1)(1)
In this section, “psychiatric hospital" means a special hospital that primarily provides psychiatric care to inpatients and outpatients. It does not include a special hospital that primarily offers treatment for alcohol abuse and drug abuse patients.
(2) Additional medical record requirements.
The medical records maintained by a psychiatric hospital shall document the degree and intensity of the treatment provided to individuals who are furnished services in the facility. A patient's medical record shall contain:
The reason for treatment or chief complaint in the words of the patient as well as observations or concerns expressed by others;
The psychiatric evaluation, including a medical history containing a record of mental status and noting the onset of illness, the circumstances leading to admission, attitudes, behavior, an estimate of intellectual functions, memory functioning, orientation and an inventory of the patient's personality assets recorded in descriptive fashion;
Social service records, including reports of interviews with patients, family members and others and providing an assessment of home plans, family attitudes and community resource contacts as well as a social history;
A comprehensive treatment plan based on an inventory of the patient's strengths and disabilities, which shall include:
The documentation of all active therapeutic efforts and interventions;
Progress notes recorded at least weekly by the physician, nurse, social worker and staff from other appropriate disciplines involved in active treatment modalities, as indicated by the patient's condition; and
Recommendations from appropriate services concerning follow-up care; and
(3) Additional treatment plan and staffing requirements. DHS 124.26(3)(a)(a)
The hospital shall have enough staff with appropriate qualifications to carry out an active program of psychiatric treatment for individuals who are furnished services in the facility.
Staff shall plan, implement and revise, as indicated, a written, individualized treatment program for each patient based on:
The degree of psychological impairment and appropriate measures to be taken to relieve treatable distress and to compensate for nonreversible impairments;
Environmental and physical limitations required to safeguard the individual's health and safety with an appropriate plan of care; and
The treatment of psychiatric inpatients shall be under the supervision of a qualified physician who shall provide for an intensive treatment program.
If nonpsychiatric medical and surgical diagnostic and treatment services are not available within the facility, qualified consultants or attending physicians shall be immediately available if a patient should need this attention, or an adequate arrangement shall be in place for immediate transfer of the patient to a general hospital.
Nursing services shall be under the direct supervision of a registered nurse qualified to care for psychiatric patients and, by demonstrated competence, to participate in interdisciplinary formulation of individual treatment plans, to give skilled nursing care and therapy, and to direct, supervise and educate others who assist in implementing the nursing component of each patient's treatment plan.