<P> 36 states require that health care workers undergo criminal background checks . </P> <P> EMTALA, enacted by the federal government in 1986, requires that hospital emergency departments treat emergency conditions of all patients regardless of their ability to pay and is considered a critical element in the "safety net" for the uninsured, but established no direct payment mechanism for such care . Indirect payments and reimbursements through federal and state government programs have never fully compensated public and private hospitals for the full cost of care mandated by EMTALA . More than half of all emergency care in the U.S. now goes uncompensated . According to some analyses, EMTALA is an unfunded mandate that has contributed to financial pressures on hospitals in the last 20 years, causing them to consolidate and close facilities, and contributing to emergency room overcrowding . According to the Institute of Medicine, between 1993 and 2003, emergency room visits in the U.S. grew by 26%, while in the same period, the number of emergency departments declined by 425 . </P> <P> Mentally ill patients present a unique challenge for emergency departments and hospitals . In accordance with EMTALA, mentally ill patients who enter emergency rooms are evaluated for emergency medical conditions . Once mentally ill patients are medically stable, regional mental health agencies are contacted to evaluate them . Patients are evaluated as to whether they are a danger to themselves or others . Those meeting this criterion are admitted to a mental health facility to be further evaluated by a psychiatrist . Typically, mentally ill patients can be held for up to 72 hours, after which a court order is required . </P> <P> Health care quality assurance consists of the "activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program . The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow - up monitoring to ensure effectiveness of corrective steps ." Private companies such as Grand Rounds also release quality information and offer services to employers and plans to map quality within their networks . </P>

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