Patient confidentiality in the emergency department

Confidentiality and privacy are words used interchangeably in the medical world when they have very different meanings. Confidentiality is in line with protection of patient information from unauthorized users and privacy is in line with protection of the patient’s physical body from unauthorized users. In the emergency department (ED) this is a lofty and constant task that requires vigilance from staff, in all departments, involved with the patient. This student will report on the issues with confidentiality in the ED.

Describe the issue and the population it affects most. There are many issues with confidentiality in the ED but this student believes that the overcrowding and “the growth in the subspecialty of Hallway Medicine” (Freeman, 2003, p. 1) is an enormous problem facing emergency department’s (ED’s). Hallway medicine happens when an ED has full rooms and the hallway gets employed as a waiting or staging area for the overflow patients. Emergency room visits by patients are not just for emergencies anymore. The ED is becoming more like an urgent care setting.

As more patients cannot pay for the medical care, they need a higher utilization of the ED is happening because the ED cannot refuse to treat a patient. This is causing an influx of patient volume. Because most ED’s have not had the opportunity to rebuild or redesign the patient rooms to single person rooms the use of curtains separating patient’s is still widely used. Some precautions have been instituted by widening the space between beds and using portable dividers there is still an issue with maintaining patient’s confidentiality.

Poor division between patients and overcrowding of ED’s can create a sense of no privacy for the necessary communication between patient and provider to happen. Patients will use the ED for a variety of ailments. If the patient feels that they may be overheard by someone other than his or her provider, he or she most likely will withhold medical history or information that the provider would need to help diagnose and treat the current problem. Supporting facts.

According to Moskop, Marco, Larkin, Geiderman, and Derse (2005), “Of the 104 patients in the latter study reported that their expectations for privacy in the ED were met, 4 patients (all in curtained treatment areas) reported withholding part of their medical history, refusing part of their examination, or both because of privacy concerns” (Moskop et al 2005, p. 1). When patients believe that someone who is not providing care directly to them can hear the intimate details of his or her medical issue he or she will most likely not share the entirety of the details.

If the patient is a celebrity, he or she will not want to share too much information for fear that the ED visit information will be sold or leaked to the press or paparazzi. Possibly, there is a family member with the patient. This person does not need to know the full extent of the patient’s medical issues. These are valid confidentiality concerns that hamper the ability of the ED physician to treat the patient. Ethical and Legal Issues The ethical issues are never-ending when dealing with patients’ confidentiality while in the ED.

The emergency department has some slightly different issues to deal with in emergent or trauma situations the need to maintain the patients’ confidentiality are still prevalent. ED physicians have to be wary of several possibilities that can affect the course of an ED visit. The safety of patients and staff is always a top priority. Depending on mental status, the severity of the injury or illness, placing the patient in a single person room or closer to the nurses’ station may be necessary to maintain safety. Law enforcement officers may need to have access to the patient to get the details of an accident or retrieve evidence.

The officers have, in some instances, the ability to access the patients because the transportation to the ED by law enforcement. Protecting the medical record is of high importance. No matter who has access to the patient the medical record must be kept confidential and not laying around for anyone to see. Legal issues around confidentiality can be just as important. Patients can record the actions of the staff in the ED. Smart phones have increased the patient’s or family member’s ability to document what is said and the actions made by the providers.

This may help a legal case if the patient has a valid complaint. The facility also has to make the medical record safe and confidential. If the medical record is on paper, then there needs to be restricted access to the area where the records are. If the medical record is electronic, safeguards in the computer programming need to shut down and lock the screen after a short period on inactivity. Managerial responsibilities related to administrative ethical issues In the article, there was no relation to managerial responsibilities.

This student believes that education to the staff as regularly as possible is the best way to make sure all staff understand the high level of confidentiality to be maintained in the ED. There should be no compromise when accessing the patients’ medical record. Regular training for the staff will be a big step in the right direction. Reaching out to ancillary departments and outside resource, law enforcement officers, to coordinate the teaching of confidentiality within patient access would also create a unity between the different people who may have access to the patient. Solutions.

Proposed solutions for maintaining confidentiality in the ED begin with making the patient feel that the space he or she are in during his or her ED visit is an audibly secure. This becomes a challenge for established older ED where curtains are still used to create a privacy barrier. One solution would be to use all individual rooms first, before using the curtained rooms. This removes any confidentiality issues at the beginning of the visit. If only curtained rooms are available space the patients in every other curtained room until it is necessary to start using the rooms in between.

Another solution may be to have portable walls that roll into place to give an added layer of sound barrier. “In an area where multiple patient-staff communications routinely occur, use of cubicles, dividers, shields, curtains, or similar barriers may constitute a reasonable safeguard” (“Using barriers,” 2002, p. 6). Conclusion In the emergency department, a patient’s visit can be very hectic and have different people discussing the patients care and care needs to be taken to ensure the patient’s confidentiality.

The patient needs to feel comfortable to share his or her health history so that the physician can make the best informed decision for the patient’s treatment. The patients’ medical record needs to be kept secure whether in a restricted area or with software that shuts down after not used for a short period. Creating an audibly secure area for the patient will help create a better ED visit for the patient.

References Freeman, J. (2003). The Emerging Subspecialty of Hallway Medicine. CJEM : Journal of the Canadian Association of Emergency Physicians, 5, 283-5. Retrieved from http://search.proquest. com. ezproxy. apollolibrary. com/docview/195782153 INCIDENTAL USES AND DISCLOSURES. (2002).

Retrieved from http://www. hhs. gov/ocr/privacy/hipaa/understanding/coveredentities/incidentalu&d. pdf Moskop, J. C. , Marco, C. A. , Larkin, G. L. , Geiderman, J. M. , & Derse, A. R. (2005, January 2005). From Hippocrates to HIPAA: Privacy and Confidentiality in Emergency Medicine–Part II: Challenges in the Emergency Department. American College of Emergency Physicians, 45, 60-66. Retrieved from http://www. sciencedirect. com. ezproxy. apollolibrary. com/science/article/pii/S019606440401282X.

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