EMS Lawline: COVID-19’s Impact on EMS Documentation Requirements

Christopher Kelly, Esq.

COVID-19 and the public health emergency it has created has changed the way we work, how we communicate, and even where we go. For many, work has become work-at-home, communication is now being done at a distance, and where we go is being limited by closures and group-size limitations. However, we’re not talking about how COVID-19 is impacting the general public; we’re speaking specifically about emergency medical services (EMS). Let’s look at some of these changes, some things that have remained the same, and consider how they impact EMS. First, the changes:

The Way We Work

Although some businesses have transitioned to work-at-home, EMS is directly in the face of this public health emergency, but it has still changed the way we work. COVID-19 has increased our usage of personal protection equipment (PPE), and deep sanitization of ambulances has become the general rule instead of the exception.

Both of these things cause crews to focus on additional tasks and to take additional time between calls, time that, in the past, was used for completing patient documentation.

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How We Communicate

The world has transitioned quickly from handshakes to fist bumps, fist bumps to elbow nudges, and elbow nudges to complete social distancing, i.e., waving to one another through webcams in Zoom meetings. Communication in EMS is changing as well. Getting signatures was once a fairly simple process, but now doctors are not in their offices to sign Physician Certification Statements (PCSs), and we don’t want patients to touch our pens, styluses, or computer screens. The Department of Health and Human Services (HHS) has acknowledged these new realities and, in certain circumstances, has waived these signature requirements.

Telehealth has also become a more common way to communicate, and HHS has waived the requirement that telehealth calls originate in health care facilities, allowing them to originate from a patient’s home. This, in turn, has EMS calling in on behalf of their patient to see if the hospital wants them to come in or stay in place.

Where We Go from Here

Restaurants and parks are closed, sporting events have been canceled, and my hair has never been so long! However, although the public is being limited in where they can go, the options for EMS providers are expanding. Hospitals are spreading into parking lots–and that isn’t even the biggest change. HHS has told us that we can transport patients to any location that can treat them. And, it’s not just for COVID patients; we can take any patient to any destination, subject to a few conditions.

The Impact of These Changes

Each of these changes bring challenges and new “hoops” you must jump through. For example, the PCS and patient signature waivers are limited. You must document that you could not obtain these signatures specifically because of COVID-19. For patients, you must also document that the patient gave verbal consent to assign their rights to bill claims.

The alternate destinations discussed above are allowed only if they are done in accordance with new protocols that state that these destinations are allowed, so you must draft and implement these protocols. Telehealth options may result in patients being left at home instead of being transported to the hospital, or they are transported to one of these alternate destinations. In these situations, you might consider a modified refusal form that states the patient understands and agrees with this course of action. Also, every change requires new policies for when they are applied and how they must be handled when they do. Crews then need training on these new policies and what is required when they encounter these new situations. Crews also need to know what to communicate to patients, especially when the traditional trip the emergency department is not suggested.

Some Things Never Change

There have been a lot of waivers, only some of which we have discussed above. However, documentation of patient care is not one of them. Regardless of time constraints and the difficulty of using and maintaining computer equipment during a public health emergency, you still must have complete documentation that must be, in some cases, more specific than ever before. Some things you must answer in your documentation include: Why was a patient taken to an alternate destination? Why was a patient not transported at all? Does the patient understand this decision? Did EMS provide telehealth communications or get direction from medical control? Why was no patient signature obtained? Did the patient give verbal consent to assign his insurance benefits? Why was no PCS obtained for a nonemergent transport? 

And, the toughest question to answer, is, “Why was a transport medically necessary?” If the only answer is “possible COVID-19″ and that is all that is documented, that is not likely going to be enough. You must document what you would normally document with all patients to paint the picture of the patient’s condition and more such as signs and symptoms, patient assessment, treatments provided, response to those treatments, how the patient was moved, the identification of people potentially exposed, PPE usage, the infection control precautions employed, isolation precautions at facilities, and guidance from protocols or medical control.

Although some things have changed dramatically because of COVID-19, other things such as the need for accurate, complete, and descriptive patient care documentation have certainly remained the same. Make sure that you are seeing the answers to these questions in your documentation; if you are not, it may be that field providers simply need some extra guidance and training in how to address these issues that they have never had to deal with before. For more information about documentation, coding, waivers, and all things COVID-19, click here.

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