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Hoops K, Hall E, Ramdath C, Lopez C. Policing of youth in the hospital. Am J Emerg Med 2024; 86:74-77. [PMID: 39368398 DOI: 10.1016/j.ajem.2024.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 09/10/2024] [Accepted: 09/20/2024] [Indexed: 10/07/2024] Open
Abstract
BACKGROUND Each year millions of children seek care in emergency departments, many of whom are from marginalized and minoritized groups who lack access to primary and preventive care. Law enforcement personnel are also commonly present in pediatric and adult emergency departments serving in a range of roles. Therefore, pediatric emergency departments sit at the nexus of the health system and the legal system for many vulnerable youth and families. OBJECTIVE Herein, we explore several common specific legal issues surrounding policing of youth in the hospital setting: patient privacy and disclosure of information, questioning and visitation restriction, autonomy and decision making, restraints and use of force, and patient property. METHODS Our team of legal scholars and clinician researchers examined the literature on policing of youth in healthcare settings and patients' legal rights in healthcare settings through searches using PubMed, Westlaw, and Lexis. FINDINGS Through rigorous analysis of the medical literature, legal scholarship, and relevant case law, several important themes were identified which present challenges to clinicians caring for vulnerable children. CONCLUSIONS AND RELEVANCE Pediatric clinicians, highly trained professionals in the medical and social care of youth and children, are often unaware of legal rules and procedures that guide law enforcement interaction with youth. This lack of knowledge may result in unknowing and unwitting violations of patients' rights while also compromising the quality of health care provided. Therefore, it is imperative that clinicians are educated on their roles and their institutions' roles in safeguarding patients' privacy and autonomy while still promoting effective collaboration with law enforcement.
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Affiliation(s)
- Katherine Hoops
- Johns Hopkins Medicine, Department of Anesthesiology and Critical Care Medicine, Baltimore, MD, USA; Georgetown University Law Center, Washington DC, USA.
| | - Erin Hall
- Georgetown University School of Medicine, Department of Surgery, Washington DC, USA
| | - Cassandra Ramdath
- Georgetown University Law Center, Center for Innovations in Community Safety, Washington DC, USA
| | - Christy Lopez
- Georgetown University Law Center, Washington DC, USA
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HIPAA and video recordings in the clinical setting. Nursing 2023; 53:15-19. [PMID: 36573862 DOI: 10.1097/01.nurse.0000902940.51519.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACT The advent of cellular network technology has increased the use of photography in the clinical setting. This article reviews several areas regarding protected health information (PHI) and the use of video: the 1996 Health Insurance Portability and Accountability Act (HIPAA); The Joint Commission requirements for the use of images; areas of concern for exchanging PHI with law enforcement at the bedside, and the need for the development of formal guidelines regarding the use of video in the clinical setting.
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Vearrier L, Derse AR, Basford JB, Larkin GL, Moskop JC. Artificial Intelligence in Emergency Medicine: Benefits, Risks, and Recommendations. J Emerg Med 2022; 62:492-499. [PMID: 35164977 DOI: 10.1016/j.jemermed.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/12/2021] [Accepted: 01/16/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Artificial intelligence (AI) can be described as the use of computers to perform tasks that formerly required human cognition. The American Medical Association prefers the term 'augmented intelligence' over 'artificial intelligence' to emphasize the assistive role of computers in enhancing physician skills as opposed to replacing them. The integration of AI into emergency medicine, and clinical practice at large, has increased in recent years, and that trend is likely to continue. DISCUSSION AI has demonstrated substantial potential benefit for physicians and patients. These benefits are transforming the therapeutic relationship from the traditional physician-patient dyad into a triadic doctor-patient-machine relationship. New AI technologies, however, require careful vetting, legal standards, patient safeguards, and provider education. Emergency physicians (EPs) should recognize the limits and risks of AI as well as its potential benefits. CONCLUSIONS EPs must learn to partner with, not capitulate to, AI. AI has proven to be superior to, or on a par with, certain physician skills, such as interpreting radiographs and making diagnoses based on visual cues, such as skin cancer. AI can provide cognitive assistance, but EPs must interpret AI results within the clinical context of individual patients. They must also advocate for patient confidentiality, professional liability coverage, and the essential role of specialty-trained EPs.
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Affiliation(s)
- Laura Vearrier
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Arthur R Derse
- Center for Bioethics, Medical Humanities, and Department of Emergency Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin
| | - Jesse B Basford
- Departments of Family and Emergency Medicine, Alabama College of Osteopathic Medicine, Dothan, Alabama
| | - Gregory Luke Larkin
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - John C Moskop
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Valizadeh F, Heshmat F, Mohammadi S, Motaghi Z. Affecting Factors of Parturient Women's Privacy Preservation in The Maternity Ward: A Qualitative Study. J Family Reprod Health 2021; 15:186-195. [PMID: 34721610 PMCID: PMC8536821 DOI: 10.18502/jfrh.v15i3.7137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Different factors have an important role in the positive and negative childbirth experiences of the mothers. The parturient mother's privacy preservation is one of the factors for increasing the mothers' satisfaction consistent with natural childbirth. Hence, this study aimed to investigate the factors affecting the parturient mother's privacy preservation. Materials and methods: Content analysis was used in this qualitative study that is based on the semi structured individual interviews with women who had experienced natural vaginal delivery, midwives, and the specialist in a maternity ward from 2018 to 2021 in Shahroud, Iran. The collected data were analyzed simultaneously with the sampling procedure using a five-step qualitative content analysis method. To ensure the robustness of the data, Lincoln and Guba's four criteria (credibility, dependability, confirmability, and transferability) were used. Results: The findings of the study with 40 participants resulted in the extraction of 28 codes, 9 subcategories, and 2 main categories entitled extra-and intra personal factors affecting the mother's privacy. Conclusion: To foster the mother's awareness of her rights and privacy during pregnancy and delivery, continuous education, monitoring, and evaluating both the students and the staff to respect preserving the mother's privacy is necessary to develop an instrument to measure the preservation of the mother's privacy in the maternity ward.
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Affiliation(s)
- Farzaneh Valizadeh
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Farahnaz Heshmat
- Medical and Health Care Center, Isfahan University Medical Sciences, Isfahan, Iran
| | - Solmaz Mohammadi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Zahra Motaghi
- Reproductive Health Department, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Beltran-Aroca CM, Ruiz-Montero R, Labella F, Girela-López E. The role of undergraduate medical students training in respect for patient confidentiality. BMC MEDICAL EDUCATION 2021; 21:273. [PMID: 33980240 PMCID: PMC8117324 DOI: 10.1186/s12909-021-02689-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Encouraging professional integrity is vital for providing a standard of excellence in quality medical care and education and in promoting a culture of respect and responsibility. The primary objective of this work consisted of studying the relationship of medical students to the right to patient privacy in Spain, specifically by analysing the conditions for accessing patient clinical histories (CHs). METHODS A cross-sectional study was conducted based on a questionnaire sent by e-mail to final-year students at 41 Spanish universities. It had 14 multiple choice and closed questions framed in 3 large blocks. The first question addressed basic general knowledge issues on the right to privacy and the obligation for confidentiality. The two remaining blocks were made up of questions directed towards evaluating the frequency with which certain requirements and action steps related to students attending patients were performed and regarding the guarantees associated with accessing and handling patient CHs both on paper and in the Electronic Medical Record. RESULTS A total of 245 valid replies were considered. A total of 67.8 % of participants were women, with an average age of 24.05 ± 3.49 years. Up to 90.6 % were aware that confidentiality affected the data in CHs, although 43.3 % possessed non-anonymized photocopies of patient clinical reports outside the healthcare context, and only 49.8 % of the students were always adequately identified. A total of 59.2 % accessed patient CHs on some occasions by using passwords belonging to healthcare professionals, 77.2 % of them did not have the patients' express consent, and 71.9 % accessed a CH that was not anonymised. CONCLUSIONS The role of healthcare institutions and universities is considered to be fundamental in implementing educational measures regarding the risks and ethical and legal problems arising from the use of CHs among professionals and students. A thorough study of medical ethics is needed through the analysis of clinical cases and direct exposure to situations in which the patient's confidentiality is questioned.
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Affiliation(s)
- Cristina M Beltran-Aroca
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Córdoba, Spain
| | - Rafael Ruiz-Montero
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain
| | - Fernando Labella
- Sección de Oftalmología, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Córdoba, Spain
| | - Eloy Girela-López
- Sección de Medicina Legal y Forense, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Córdoba, Spain
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Koskimies E, Koskinen S, Leino-Kilpi H, Suhonen R. The informational privacy of patients in prehospital emergency care-Integrative literature review. J Clin Nurs 2020; 29:4440-4453. [PMID: 32891066 DOI: 10.1111/jocn.15481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore the informational privacy of patients in prehospital emergency care based on the existing literature. BACKGROUND Informational privacy, a central value in health care, is strongly connected to patients' safety and quality of care. However, its realisation faces challenges in the unique context of prehospital emergency care. DESIGN Integrative literature review. METHODS Systematic searches of the CINAHL, MEDLINE and Cochrane library databases (n = 1588) and a manual search of the reference lists of the included articles (n = 0) were conducted in August 2019. In the article selection, specified inclusion and exclusion criteria were used. Two Joanna Briggs Institute quality appraisal tools were used. Ultimately, 11 studies were included. Analysis was conducted by using content analysis. Overall, process of the review was guided by PRISMA checklist. RESULTS The number of primary research studies related to informational privacy in prehospital emergency care is limited and mainly focused on privacy and confidentiality. The informational privacy was described from three aspects (a) information control by patients, (b) information protection by healthcare professional and (c) concepts related to informational privacy. The realisation of patients' informational privacy varied. Factors related to the realisation were related to the paramedics, the prehospital emergency care work and the patients. CONCLUSION More research specifically focused on informational privacy in prehospital emergency care is needed. Paramedics' understanding of informational privacy and its protection is essential to enhance the realisation of patients' informational privacy. Therefore, a response is required to their need for more education concerning informational privacy. RELEVANCE TO CLINICAL PRACTICE Paramedics' attention should be drawn to the identified factors related to the realisation of informational privacy and its use in clinical practice in order to continue to provide high-quality prehospital emergency care.
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Affiliation(s)
- Eini Koskimies
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Sanna Koskinen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland.,Welfare Division, Turku University Hospital and City of Turku, Turku, Finland
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Abstract
This article focuses on confidentiality and capacity issues affecting patients receiving care in the emergency department. The patient-physician relationship begins with presumed confidentiality. The article also clarifies instances where a physician may be required to break confidentiality for the safety of patients or others. This article then discusses risk management issues relevant to determining a patient's capacity to accept or decline medical care in the emergency department setting. Situations pertaining to refusal of care and discharges against medical advice are examined in detail, and best practices for mitigating risk in informed consent and barriers to consent are reviewed.
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Affiliation(s)
- Joseph H Kahn
- Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118, USA.
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Kuo TT, Kim J, Gabriel RA. Privacy-preserving model learning on a blockchain network-of-networks. J Am Med Inform Assoc 2020; 27:343-354. [PMID: 31943009 PMCID: PMC7025358 DOI: 10.1093/jamia/ocz214] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/04/2019] [Accepted: 12/02/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To facilitate clinical/genomic/biomedical research, constructing generalizable predictive models using cross-institutional methods while protecting privacy is imperative. However, state-of-the-art methods assume a "flattened" topology, while real-world research networks may consist of "network-of-networks" which can imply practical issues including training on small data for rare diseases/conditions, prioritizing locally trained models, and maintaining models for each level of the hierarchy. In this study, we focus on developing a hierarchical approach to inherit the benefits of the privacy-preserving methods, retain the advantages of adopting blockchain, and address practical concerns on a research network-of-networks. MATERIALS AND METHODS We propose a framework to combine level-wise model learning, blockchain-based model dissemination, and a novel hierarchical consensus algorithm for model ensemble. We developed an example implementation HierarchicalChain (hierarchical privacy-preserving modeling on blockchain), evaluated it on 3 healthcare/genomic datasets, as well as compared its predictive correctness, learning iteration, and execution time with a state-of-the-art method designed for flattened network topology. RESULTS HierarchicalChain improves the predictive correctness for small training datasets and provides comparable correctness results with the competing method with higher learning iteration and similar per-iteration execution time, inherits the benefits of the privacy-preserving learning and advantages of blockchain technology, and immutable records models for each level. DISCUSSION HierarchicalChain is independent of the core privacy-preserving learning method, as well as of the underlying blockchain platform. Further studies are warranted for various types of network topology, complex data, and privacy concerns. CONCLUSION We demonstrated the potential of utilizing the information from the hierarchical network-of-networks topology to improve prediction.
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Affiliation(s)
- Tsung-Ting Kuo
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Jihoon Kim
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Rodney A Gabriel
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
- Department of Anesthesiology, University of California San Diego, San Diego, California, USA
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Prescription Drug Monitoring Programs: Ethical Issues in the Emergency Department. Ann Emerg Med 2016; 68:589-598. [DOI: 10.1016/j.annemergmed.2016.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/12/2016] [Accepted: 04/13/2016] [Indexed: 01/26/2023]
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10
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Allen NG, Khan JS, Alzahri MS, Stolar AG. Ethical Issues in Emergency Psychiatry. Emerg Med Clin North Am 2015; 33:863-74. [DOI: 10.1016/j.emc.2015.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Managing Law Enforcement Presence in the Emergency Department: Highlighting the Need for New Policy Recommendations. J Emerg Med 2015; 49:523-9. [PMID: 26095221 DOI: 10.1016/j.jemermed.2015.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 03/30/2015] [Accepted: 04/07/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Emergency Department (ED) is the portal of entry to the health care system for a large percentage of patients. This is especially true for victims and perpetrators of interpersonal violence. Frequently, law enforcement personnel (LEP) accompany patients to the ED or seek access to patients during their ED stay or subsequent hospitalization. The time-sensitive nature of both emergency care and criminal investigation motivates both health care personnel and LEP, and can lead to potential conflicts of interest regarding access to patients in the ED. OBJECTIVES We hope to examine the relationship among patients, providers, and LEP in the ED, and the potential impact these interactions have on patient care. This article presents a review of the relevant literature and policy consideration as well as provides guidance on the development of such policies for EDs. DISCUSSION Hospitals, EDs, and trauma resuscitation rooms are highly regulated environments, but LEP largely fall outside the ethical and institutional guidelines of health care institutions. Many potential areas of conflict exist when LEP are present in the ED that can have detrimental effects on patient care, provider liability, and LEP efficacy. Patients' perceptions of collaboration between ED personnel and LEP can compromise emergency patient care. CONCLUSION There is a need for hospital policies to govern interactions among patients, emergency health care providers, and LEP in the ED.
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Communicating With the Adolescent: Consent and Confidentiality Issues. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2015. [DOI: 10.1016/j.cpem.2015.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Tragic accidents, e.g. involving celebrity patients or severe incidents in hospital occur suddenly without any advance warning, often produce substantial interest by the media and quickly overburden management personnel involved in both hospitals and emergency medical services. While doctors, hospitals and emergency medical services desire objective media reports, the media promote emotionalized and dramatized reports to ensure maximum attention and circulation. When briefing the media, the scales may quickly tilt from professional, well-deliberated information to unfortunate, often unintended disinformation. Such phenomena may result in continuing exaggerated reports in the tabloid press, which in the presence of aggressive lawyers and a competitive hospital environment can turn into image and legal problems. In this article, several aspects are discussed in order to achieve successful public relations.Interviews should be given only after consultation with the responsible press officer and the director of the respective department or hospital director. Requests for information by the media should always be answered as otherwise one-sided, unintentional publications can result that are extremely difficult to correct later. One should be available to be contacted easily by journalists, regular press conferences should be held and critics should be taken seriously and not be brushed off. Questions by journalists should be answered in a timely manner as journalists are continuously under time pressure and do not understand unnecessary delays. Information for the media should always be provided at the same time, no publication should be given preference and an absolutely current list of E-mail contacts is required. When facing big events a press conference is preferred as many questions can be answered at once. Always be well prepared for an interview or even for just a statement. Each interview should be regarded as an opportunity to put a story forward which you wanted to do for a long time and your message should not contain more than three main points.Each hospital or emergency medical service should have a professional department for public relations, an exact knowledge of the regional and national media and strategies how to handle an incident that is of interest for the media. The media should be provided with information not only when a negative incident has happened but should be provided with regular positive messages as well. An interview must be carefully prepared to achieve a good image.
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Zafar W. Moral experience and ethical challenges in an emergency department in Pakistan: emergency physicians’ perspectives. Emerg Med J 2014; 32:263-8. [DOI: 10.1136/emermed-2014-204081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ng'anjo Phiri S, Fylkesnes K, Ruano AL, Moland KM. 'Born before arrival': user and provider perspectives on health facility childbirths in Kapiri Mposhi district, Zambia. BMC Pregnancy Childbirth 2014; 14:323. [PMID: 25223631 PMCID: PMC4171557 DOI: 10.1186/1471-2393-14-323] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Maternal mortality remains high in sub-Saharan Africa. Health facility intra-partum strategies with skilled birth attendance have been shown to be most effective to address maternal mortality. In Zambia, the health policy for pregnant women is to have facility childbirth, but less than half of the women utilize the facilities for delivery. ‘Born before arrival’ (BBA) describes childbirth that occurs outside health facility. With the aim to increase our understanding of trust in facility birth care we explored how users and providers perceived the low utilization of health facilities during childbirth. Methods A qualitative study was conducted in Kapiri Mposhi, Zambia. Focus group discussions with antenatal clinic and outpatient department attendees were conducted in 2008 as part of the Response to Accountable priority setting and Trust in health systems project, (REACT). In-depth interviews conducted with women who delivered at home, their husbands, community leaders, traditional birth attendants, and midwives were added in 2011. Information was collected on perceptions and experiences of home and health facility childbirth, and reasons for not utilizing a facility at delivery. Data were analysed by inductive content analysis. Results Perspectives of users and providers were grouped under themes that included experiences related to promotion of facility childbirth, responsiveness of health care providers, and giving birth at home. Trust and quality of care were important when individuals seek facility childbirth. Safety, privacy and confidentiality encouraged facility childbirth. Poor attitudes of health providers, long distances and lack of transport to facilities, costs to buy delivery kits, and cultural ideals that local herbs speed up labour and women should exhibit endurance at childbirth discouraged facility childbirth. Conclusion Trust and perceived quality of care were important and influenced health care seeking at childbirth. Interventions that include both the demand and supply sides of services with prioritizing needs of the community could substantially improve trust and utilization of facilities at childbirth, and accelerate efforts to achieve MDG5. Electronic supplementary material The online version of this article (doi:10.1186/1471-2393-14-323) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Selia Ng'anjo Phiri
- Centre for International Health, Department of Global Health and Primary Care, University of Bergen, Bergen, Norway.
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18
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Carter EJ, Pouch SM, Larson EL. Common infection control practices in the emergency department: a literature review. Am J Infect Control 2014; 42:957-62. [PMID: 25179326 PMCID: PMC4340698 DOI: 10.1016/j.ajic.2014.01.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 01/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health care-associated infections (HAIs) are a major health concern, despite being largely avoidable. The emergency department (ED) is an essential component of the health care system and subject to workflow challenges, which may hinder ED personnel adherence to guideline-based infection prevention practices. METHODS The purpose of this review was to examine published literature regarding adherence rates among ED personnel to selected infection control practices, including hand hygiene (HH) and aseptic technique during the placement of central venous catheters and urinary catheters. We also reviewed studies reporting rates of ED equipment contamination. PubMed was searched for studies that included adherence rates among ED personnel to HH during routine patient care, aseptic technique during the placement of central venous catheters and urinary catheters, and rates of equipment contamination. RESULTS In total, 853 studies was screened, and 589 abstracts were reviewed. The full texts of 36 papers were examined, and 23 articles were identified as meeting inclusion criteria. Eight studies used various scales to measure HH compliance, which ranged from 7.7% to 89.7%. Seven articles examined central venous catheters inserted in the ED or by emergency medicine residents. Detail of aseptic technique practices during urinary catheterization was lacking. Four papers described equipment contamination in the ED. CONCLUSION Standardized methods and definitions of compliance monitoring are needed to compare results across settings.
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Affiliation(s)
| | - Stephanie M Pouch
- College of Physicians and Surgeons, Columbia University, New York, NY
| | - Elaine L Larson
- School of Nursing, Columbia University, New York, NY; Mailman School of Public Health, Columbia University, New York, NY
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Williams JR, Schafer MF. HIPAA and its effect on graduate medical education: a literature review. J Bone Joint Surg Am 2014; 96:e13. [PMID: 24430422 DOI: 10.2106/jbjs.m.00530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Joan R Williams
- 910 North Lake Shore Drive #2418, Chicago, IL 60611. E-mail address:
| | - Michael F Schafer
- Department of Orthopaedics, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL 60611
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20
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Calleja P, Forrest L. Improving patient privacy and confidentiality in one regional Emergency Department – A quality project. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.aenj.2011.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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22
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Mermelstein HT, Wallack JJ. Confidentiality in the age of HIPAA: a challenge for psychosomatic medicine. PSYCHOSOMATICS 2008; 49:97-103. [PMID: 18354061 DOI: 10.1176/appi.psy.49.2.97] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This review, a work project of The Standards and Ethics Committee of The Academy of Psychosomatic Medicine, examines the challenges posed for consultation-liaison psychiatrists as they struggle to maintain the trust between patient and physician while balancing compliance with the increasing complexities of confidentiality with the provision of enough information to our medical colleagues for good clinical care. The authors discuss the moral, legal, and ethical issues that arise from the many-layered state and federal regulations, especially the impact of the Health Information Portability and Accountability Act (HIPPA) and make recommendations for practical application in the clinical setting.
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Affiliation(s)
- Hindi T Mermelstein
- Department of Psychiatry, North Shore University Hospital, North Shore LIJ Health System, Mount Sinai School of Medicine, Great Neck, NY 11021, USA.
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Aronsky D, Jones I, Lanaghan K, Slovis CM. Supporting patient care in the emergency department with a computerized whiteboard system. J Am Med Inform Assoc 2007; 15:184-94. [PMID: 18096913 DOI: 10.1197/jamia.m2489] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Efficient information management and communication within the emergency department (ED) is essential to providing timely and high-quality patient care. The ED whiteboard (census board) usually serves as an ED's central access point for operational and patient-related information. This article describes the design, functionality, and experiences with a computerized ED whiteboard, which has the ability to display relevant operational and patient-related information in real time. Embedded functionality, additional whiteboard views, and the integration with ED and institutional information system components, such as the computerized patient record or the provider order entry system, provide rapid access to more detailed information. As an information center, the computerized whiteboard supports our ED environment not only for providing patient care, but also for operational, educational, and research activities.
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Affiliation(s)
- Dominik Aronsky
- Department of Biomedical Informatics, Eskind Biomedical Library, Vanderbilt University Medical Center, 2209 Garland Ave, Nashville, TN 37232-8340, USA.
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Ethical Considerations About Observational Research in Children. ACTA ACUST UNITED AC 2007; 63:S146-51; discussion S152-4. [DOI: 10.1097/ta.0b013e31815acd60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morris MC, Mechem CC, Berg RA, Bobrow BJ, Burns S, Clark L, De Maio VJ, Kusick M, Richmond NJ, Stiell I, Nadkarni VM. Impact of the privacy rule on the study of out-of-hospital pediatric cardiac arrest. PREHOSP EMERG CARE 2007; 11:272-7. [PMID: 17613899 DOI: 10.1080/10903120701348123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The Privacy Rule, a follow-up to the Health Insurance Portability and Accountability Act, limits distribution of protected health information. Compliance with the Privacy Rule is particularly challenging for prehospital research, because investigators often seek data from multiple emergency medical services (EMS) and receiving hospitals. OBJECTIVE To describe the impact of the Privacy Rule on prehospital research and to present strategies to optimize data collection in compliance with the Privacy Rule. Methods. The CanAm Pediatric Cardiopulmonary Arrest Study Group has previously conducted a multicentered observational study involving children with out-of-hospital cardiac arrest. In the current study, we used a survey to assess site-specific methods of compliance with the Privacy Rule and the extent to which such strategies were successful. RESULTS The previously conducted observational study included collection of data from a total of 66 EMS agencies (range of 1-37 per site). Data collection from EMS providers was complicated by the lack of a systematic approval mechanism for the research use of EMS records and by incomplete resuscitation records. Agencies approached for approval to release EMS data for study purposes included Department of Health Institutional Review Boards, Fire Commissioners, and Commissioners of Health. The observational study included collection of data from a total of 164 receiving hospitals (range of 1-63 per site). Data collection from receiving hospitals was complicated by the varying requirements of receiving hospitals for the release of patient survival data. CONCLUSIONS Obtaining complete EMS and hospital data is challenging but is vital to the conduct of prehospital research. Obtaining approval from city or state level IRBs or Privacy Boards may help optimize data collection. Uniformity of methods to adhere to regulatory requirements would ease the conduct of prehospital research.
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Affiliation(s)
- Marilyn C Morris
- Department of Pediatrics, Division of Pediatric Critical Care, The Children's Hospital of New York-Presbyterian, Columbia University, New York, New York 10032, USA.
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Geiderman JM, Moskop JC, Derse AR. Privacy and confidentiality in emergency medicine: obligations and challenges. Emerg Med Clin North Am 2006; 24:633-56. [PMID: 16877134 PMCID: PMC7132767 DOI: 10.1016/j.emc.2006.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Respect for privacy and confidentiality have been professional responsibilities of physicians throughout recorded history. This article reviews the moral, religious, and legal foundations of privacy and confidentiality and discusses the distinction between these two closely related concepts. Current federal and state laws are reviewed, including HIPAA regulations and their implications for research and care in the emergency department. In the emergency department, privacy and confidentiality often are challenged by physical design, crowding, visitors, film crews, communication, and other factors. These problems are reviewed, and advice and guidelines are offered for helping preserve patients' dignity and rights to privacy and confidentiality.
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Affiliation(s)
- Joel Martin Geiderman
- Ruth and Harry Roman Emergency Department, Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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Teshome G, Closson FT. Emergency Medical Treatment and Labor Act: the basics and other medicolegal concerns. Pediatr Clin North Am 2006; 53:139-55, vii. [PMID: 16487788 DOI: 10.1016/j.pcl.2005.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Emergency Medical Treatment and Labor Act (EMTALA) was enacted by Congress because of its concern with an increasing number of reports that hospital emergency rooms were refusing to accept or treat individuals with emergency conditions if the individuals did not have insurance. With increasingly crowded emergency departments and a decreasing number of emergency departments, a periodic review of the effect that EMTALA has on the emergency medical services will prevent unintended consequences of this well-intentioned act.
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Affiliation(s)
- Getachew Teshome
- Department of Pediatrics, Division of Emergency Medicine, University of Maryland Hospital for Children, 22 South Greene Street, Baltimore, MD 21201, USA.
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Abstract
HIPAA regulations have been seen by many physicians as providing innumerable administrative hoops that require jumping through with no clear benefit for individual patients. Although this article has not comprehensively explored the requirements of HIPAA regulations, it has focused on the issues of "incidental disclosures" that are so important to the daily interactions of physicians and patients. Through the use of illustrative cases, it has been shown that HIPAA regulations frequently are based on well-accepted ethical principles. Although one should never conclude that changing something from an ethical responsibility to a legal responsibility makes it more important, there is no question that HIPAA regulations have forced physicians to consider more carefully how confidential information may be transmitted to others. As such, physicians should look on HIPAA regulations as largely supporting the use of professional judgment in providing good quality medical care. Although not all aspects of HIPAA are grounded in ethical practices, the overall thrust of the HIPAA regulations is consistent with the ethical practice of medicine and surgery. As a result of this general alignment of the legal and ethical requirements, more attention should be directed by physicians at using good judgment in deciding how to disclose private information, rather than adopting an unreasonable approach that confidentiality may never be breached. As Lo and colleagues have very appropriately pointed out: In the context of inadvertent disclosure, the legal risks of good practice are very low. Physicians should work with risk managers and practice administrators to develop policies that promote good communication in patient care, while taking appropriate steps to protect patient privacy. By adopting such an approach to HIPAA, physicians can abide by the regulations while maintaining high ethical standards and minimizing the impact of the new requirements on physician-patient relationships.
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Affiliation(s)
- Peter Angelos
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
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Wilsey BL, Fishman SM, Ogden C. Prescription opioid abuse in the emergency department. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2005; 33:770-82. [PMID: 16686246 DOI: 10.1111/j.1748-720x.2005.tb00543.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Barth L Wilsey
- University of California, Davis, VANCHCS/UCD Analgesic Research Center, USA
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