Professional Practice, Ethics, and Emergency Department Operations
Legal duties you cannot delegate away
EMTALA requires a medical screening examination and stabilizing treatment before any discussion of payment, and transfer only after certification of benefit and acceptance by a receiving facility; delays for insurance authorization are a classic violation. Consent requires capacity, information, and voluntariness; emergencies permit implied consent, and minors require parent or guardian consent except in defined situations such as emancipated minors or emergencies.
Ethics and mandated reporting
Know how to handle capacity disputes, refusal of care by a competent adult, advance directives and POLST, confidentiality exceptions under HIPAA, mandatory reporting of abuse and neglect, and indicators of human trafficking. Ethical frameworks - beneficence, autonomy, nonmaleficence, justice - are the vocabulary these questions use.
Operations
Triage acuity systems, surge and disaster triage (START), boarding and its downstream harms, ED metrics such as length of stay and left-without-being-seen, staffing and patient flow, just culture and incident reporting, and scope of practice with supervision requirements.
Traps
Confusing capacity (clinical and decision-specific) with competence (legal); accepting a refusal from a patient with delirium; discussing finances before the medical screening exam; documenting opinions rather than objective findings.
Rule of thumb
When a legal or ethical question feels ambiguous, choose the option that protects patient safety and the patient's right to decide - and act first if the delay itself would cause harm.