Proper patient evaluation is a major problem for smaller facilities that do not have a physician on duty at all times. These facilities usually have a physician on call who is summoned if the admitting clerk determines that the patient needs care. If there is no physician on duty, the admitting clerk should always be a nurse. The nurse should have specific, written guidelines establishing when the physician is to be called. From these guidelines, and their observance by the nurse, it should be clear that the decision to call the physician is made solely on medical as opposed to financial grounds. The guidelines should be very conservative, requiring the physician to be called in all questionable situations. The physician should understand that by accepting the responsibility of being on call, the physician has a duty to treat all patients in need of emergency care. The facility, as well as the physician, may be liable if the physician refuses to treat an emergency patient. The facilities should also inform all local ambulance services and police departments that they cannot handle major trauma.
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