A qualified medical practitioner (QMP) must provide
the medical screening exam, according to EMTALA.
Triage is not a screening exam. However, nurse practitioners
(NPs), physician assistants (PAs), and certified
registered nurses (RNs) can perform focused exams
that would meet the criteria for medical screening for
many conditions under the appropriate protocols.
Physicians should supervise these programs, but
there are no specific requirements for physician notification, consultation and attendance, except for patients
in labor and other conditions that the hospital
lists in its protocols. Rural hospitals with standby EDs
are the ideal setting for such RN/QMP programs, and
are a major reason for CMS’ adoption of this flexible
standard.
Generally, when a hospital has emergency physicians
on duty, this responsibility is vested in the
physicians, because they are deemed qualified by
their training, and no complex programs, policies or
procedures are required.