CMS SOM App. PP, Tag F713

The facility must provide or arrange for the provision of physician services 24 hours

a day, in case of emergency.

GUIDANCE §483.30(d)

If a resident’s attending physician is unavailable, the facility should attempt to contact the

physician covering for the attending physician before assuming the responsibility of

contacting another physician.

Arranging for physician services may include assuring resident transportation to a

hospital emergency room or other medical facility if the facility is unable to meet the

particular medical need at the facility. The provision of transportation does not remove

the facility’s responsibility to have a physician available, 24 hours a day, to respond to

emergencies that do not require medical care in an alternative setting.

PROBES §483.30(d)

• Does the facility have a physician on-call for medical emergencies? Does this

physician respond?

• In emergency situations, are residents unnecessarily sent to hospital emergency

rooms due to the lack of physician availability or inability to contact a physician?

Consider whether the resident’s needs could have been met in the facility had the

facility had a physician available.

• If the facility did not arrange for the provision of physician services 24 hours a

day, for emergencies, what was the impact on residents?

DEFICIENCY CATEGORIZATION §483.30(c)

Example of Level 4, immediate jeopardy to resident health and safety, includes, but

is not limited to:

• The attending physician, who was the only physician of the facility and the

medical director, failed to have an alternate physician or non-physician

practitioner available for the residents in case of an emergency, when he left the

country. The facility did not have an agreement with another physician to provide

physician services in the absence of the attending physician. When a resident with

a known history of congestive heart failure developed edema in the lower

extremities, the facility did not have a physician to contact for consultation and

new orders for interventions, resulting in hospitalization of the resident.

Example of level 3, actual harm that is not immediate jeopardy includes, but is not

limited to:

• The facility received laboratory results indicating that a resident had a urinary

tract infection (UTI). Attempts to contact the attending physician were

unsuccessful, and the facility did not have an alternate physician on-call for

emergencies. The facility did not secure timely medical treatment at the local

hospital or alternate medical facility for the resident resulting in progression of the

infection before interventions were implemented.

Example of Level 2, no actual harm, with potential for than more than minimal

harm, that is not immediate jeopardy, includes, but is not limited to:

• The facility failed to ensure the physician responded promptly to notification of a

resident’s fall. Phone calls from the licensed nurses about the fall and the swelling

of the left ankle were not returned for 24-hours and the facility did not secure

alternate medical intervention for the resident during this time.

Example of Level 1, no actual harm with potential for no more than a minor

negative impact on the resident, includes, but is not limited to:

• The failure of the facility to provide physician services 24-hours a day, in case of

an emergency, places the resident at risk for more than minimal harm. Therefore,

Severity Level 1 does not apply for this regulatory requirement.