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Suh M, Molina MF, Chary AN, Farrell CM, Mycyk MB, Eswaran V. A multi-site assessment of emergency staff knowledge, attitudes, and practices regarding care for incarcerated patients. Am J Emerg Med 2024:S0735-6757(24)00250-X. [PMID: 38849223 DOI: 10.1016/j.ajem.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/30/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024] Open
Affiliation(s)
- Michelle Suh
- Section of Emergency Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5068, Chicago, IL 60637, USA.
| | - Melanie F Molina
- UCSF Department of Emergency Medicine, Room L-126, Box 0209, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Anita N Chary
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, Campus Box 8072, Saint Louis, MO 63110, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Center for Innovations in Quality, Effectiveness and Safety, 2450 Holcombe Blvd., Suite 01Y, Houston, TX 77021, USA.
| | - Caitlin M Farrell
- Department of Emergency Medicine, Boston University, 800 Harrison Avenue, Boston, MA 02118, USA.
| | - Mark B Mycyk
- Department of Emergency Medicine, Cook County Health, 1950 W Polk Street, Chicago, IL 60612, USA.
| | - Vidya Eswaran
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, Campus Box 8072, Saint Louis, MO 63110, USA.
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Jones EV, Bourgois P, Song JS, Chong VE. "You Have to Be a Doctor First": Trauma Surgeons' Perspectives on Police Interactions in the Hospital. Am Surg 2024:31348241250037. [PMID: 38703056 DOI: 10.1177/00031348241250037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
BACKGROUND Police activity in emergency medical settings has been shown to complicate the care of patients and impact patient-provider relationships. Recent scholarship has called for clear hospital policy outlining the terms of police access to patients and the role of clinicians. Despite regular contact between trauma surgeons and police, research on the impact of police activity on trauma care has been limited. METHODS Semi-structured interviews were conducted with attending trauma surgeons and general surgery residents (N = 13) at 3 urban hospitals about their interactions with police in clinical settings. Participants were recruited using snowball sampling. Interviews were audio-recorded, transcribed, and analyzed for recurrent themes using an iterative grounded theory process. RESULTS Participants reported routine contact with police that required active negotiation of the scope of clinical and police authority in the hospital. These negotiations were shaped by prior experiences, perceptions of police, officer behavior, and institutional culture. Surgeons felt compelled to advocate for patients, but reported intimidation in moments of conflict. Participants noted uncertainty around the legal dimensions of their relationship to police and a lack of universal guidance on appropriate responses. DISCUSSION This data points to the need for improvements in both policy and workflow to regulate and reduce the burden of these interactions and protect clinicians' priorities from being subordinated to those of police. Further research is needed to understand how police presence impacts patient outcomes, and to guide best practices for regulating and mitigating potential negative impact.
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Affiliation(s)
- Emily V Jones
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
- Department of Anthropology, University of California Los Angeles, Los Angeles, CA, USA
| | - Ji Seon Song
- University of California, Irvine School of Law, Irvine, CA, USA
| | - Vincent E Chong
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA, USA
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Wardrop R, Ranse J, Crilly J, Stubbs N, Chaboyer W. Clinicians' experiences of caring for people brought in by police to the emergency department: A qualitative interpretive study. J Adv Nurs 2024; 80:1955-1966. [PMID: 37994190 DOI: 10.1111/jan.15944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023]
Abstract
AIM To explore nurses' and doctors' experiences of providing care to people brought in by police (BIBP) to the emergency department (ED). DESIGN A qualitative interpretive study using in-depth individual interviews. METHODS Semi-structured interviews were conducted with nurses and doctors who worked in various EDs in one Australian state and were involved in the care of people BIBP. Interviews were undertaken between May and October 2022 and focused on the structures (i.e., what), processes (i.e., how) and outcomes of care for people BIBP. Data were analysed using deductive and then inductive content analysis. RESULTS Nine nurses and eight doctors were interviewed. Structures described by participants included human structures (staff) and organizational structures (areas for assessment, involuntary assessment orders, investigations, chemical/physical restraints). For processes, participants described practices including risk/mental health assessments, legal considerations, and increased/decreased levels of care compared to other presentations. Communication processes were largely between police and health care staff. Service outcomes pertained to discharge location (custody, community, hospital admission) and length of stay. CONCLUSION The current care delivery for people BIBP to the ED is unique and complex, often occurring in high traffic, resource-intensive areas. There is a need to strengthen structures and processes, to improve service outcomes. IMPLICATIONS FOR THE PROFESSION Understanding the care requirements for people brought into ED by police enables the delivery of targeted care alongside appropriate resource allocation. IMPACT This study provides a comprehensive understanding of the health care requirements for people BIBP to EDs. Interventions delivered in the ED to support health care delivery for people BIBP and foster clinician and police relationships are required to optimize patient and health service outcomes. REPORTING METHOD This study adheres to the COREQ checklist (Table S1) of the EQUATOR guidelines. PATIENT OR PUBLIC CONTRIBUTION This study focused on ED staff experiences.
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Affiliation(s)
- Rachel Wardrop
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Centre for Mental Health, Griffith University, Southport, Queensland, Australia
| | - Nicole Stubbs
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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4
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Brandenburg C, Thomas SD, Lincoln C, Somerville A, Heffernan E, Kinner SA, Byrnes J, Gardiner P, Davidson P, Daley N, Green D, Crilly J. Supporting equitable care of patients transferred from police watch-houses to the emergency department: A qualitative study of the perspectives of emergency doctors. Emerg Med Australas 2024. [PMID: 38650377 DOI: 10.1111/1742-6723.14408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/05/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE People detained in short-term police custody often have complex health conditions that may necessitate emergency care, yet little is known about their management in EDs. The present study aimed to understand ED doctors' experiences and perceptions regarding the appropriateness and management of detainee transfers from police watch-houses to the EDs. METHODS A qualitative descriptive study, using semi-structured interviews undertaken with ED doctors working in five purposively sampled EDs across Queensland, Australia. Data were analysed using inductive content analysis. RESULTS Fifteen ED specialists and trainees participated. Participants reported that their overarching approach was to provide equitable care for watch-house detainees, as they would for any patient. This equitable approach needed to be responsive to complicating factors common to this population, including presence of police guards; restraints; complexity (physical/mental/social) of presentation; reliance on police to transport; ED doctors' often limited understanding of the watch-house environment; justice processes and uncertain legal disposition; communication with the watch-house; and detainees misreporting symptoms. Thresholds for assessment and treatment of detainees were contextualised to the needs of the patient, ED environment, and imperatives of other relevant agencies (e.g. police). Participants often relied on existing strategies to deliver quality care despite challenges, but also identified a need for additional strategies, including education for ED staff; improved communication with watch-houses; standardised paperwork; extended models of watch-house healthcare; and integrated medical records. CONCLUSIONS Providing equitable healthcare to patients transported from watch-houses to the EDs is challenging but essential. Numerous opportunities exist to enhance the delivery of optimal care for this underserved population.
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Affiliation(s)
- Caitlin Brandenburg
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Stuart Dm Thomas
- Social and Global Studies Centre, RMIT University, Melbourne, Victoria, Australia
| | - Cathy Lincoln
- Forensic Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Annabel Somerville
- Forensic Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Department of Emergency Medicine, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Ed Heffernan
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Forensic Mental Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Justice Health Group, Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Justice Health Group, Curtin University, Perth, Western Australia, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Paul Gardiner
- Cairns Watch-House, Far North District, Queensland Police Service, Cairns, Queensland, Australia
| | - Peter Davidson
- Division of Infectious Disease & Global Public Health, Department of Medicine, University of California, San Diego, California, USA
| | - Nathan Daley
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - David Green
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Centre for Mental Health, Griffith University, Gold Coast, Queensland, Australia
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Li S, Qin C, Zhang H, Maimaitiming M, Shi J, Feng Y, Huang K, Bi Y, Wang M, Zhou Q, Jin Y, Zheng ZJ. Survival After Out-of-Hospital Cardiac Arrest Before and After Legislation for Bystander CPR. JAMA Netw Open 2024; 7:e247909. [PMID: 38669021 PMCID: PMC11053379 DOI: 10.1001/jamanetworkopen.2024.7909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/23/2024] [Indexed: 04/29/2024] Open
Abstract
Importance The lack of evidence-based implementation strategies is a major contributor to increasing mortality due to out-of-hospital cardiac arrest (OHCA) in developing countries with limited resources. Objective To evaluate whether the implementation of legislation is associated with increased bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use and improved clinical outcomes for patients experiencing OHCA and to provide policy implications for low-income and middle-income settings. Design, Setting, and Participants This observational cohort study analyzed a prospective city registry of patients with bystander-witnessed OHCA between January 1, 2010, and December 31, 2022. The Emergency Medical Aid Act was implemented in Shenzhen, China, on October 1, 2018. An interrupted time-series analysis was used to assess changes in outcomes before and after the law. Data analysis was performed from May to October 2023. Exposure The Emergency Medical Aid Act stipulated the use of AEDs and CPR training for the public and provided clear legal guidance for OHCA rescuing. Main Outcomes and Measures The primary outcomes were rates of bystander-initiated CPR and use of AEDs. Secondary outcomes were rates of prehospital return of spontaneous circulation (ROSC), survival to arrival at the hospital, and survival at discharge. Results A total of 13 751 patients with OHCA (median [IQR] age, 59 [43-76] years; 10 011 men [72.83%]) were included, with 7858 OHCAs occurring during the prelegislation period (January 1, 2010, to September 30, 2018) and 5893 OHCAs occurring during the postlegislation period (October 1, 2018, to December 31, 2022). The rates of bystander-initiated CPR (320 patients [4.10%] vs 1103 patients [18.73%]) and AED use (214 patients [4.12%] vs 182 patients [5.29%]) increased significantly after legislation implementation vs rates before the legislation. Rates of prehospital ROSC (72 patients [0.92%] vs 425 patients [7.21%]), survival to arrival at the hospital (68 patients [0.87%] vs 321 patients [5.45%]), and survival at discharge (44 patients [0.56%] vs 165 patients [2.80%]) were significantly increased during the postlegislation period. Interrupted time-series models demonstrated a significant slope change in the rates of all outcomes. Conclusions and Relevance These findings suggest that implementation of the Emergency Medical Aid Act in China was associated with increased rates of CPR and public AED use and improved survival of patients with OHCA. The use of a systemwide approach to enact resuscitation initiatives and provide legal support may reduce the burden of OHCA in low-income and middle-income settings.
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Affiliation(s)
- Siwen Li
- Shenzhen Center for Prehospital Care, Futian District, Shenzhen, China
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Chongzhen Qin
- Shenzhen Center for Prehospital Care, Futian District, Shenzhen, China
| | - Hongjuan Zhang
- Shenzhen Center for Prehospital Care, Futian District, Shenzhen, China
| | - Mailikezhati Maimaitiming
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Junyi Shi
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - YiKai Feng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Kepei Huang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Yanxin Bi
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Minmin Wang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Qiang Zhou
- Shenzhen Center for Prehospital Care, Futian District, Shenzhen, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
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Chao S, Weber W, Iserson KV, Goett R, Baker EF, McGuire SS, Bissmeyer P, Derse AR, Kumar N, Brenner JM. Best practice guidelines for evaluating patients in custody in the emergency department. J Am Coll Emerg Physicians Open 2024; 5:e13143. [PMID: 38524358 PMCID: PMC10960077 DOI: 10.1002/emp2.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Patients in custody due to arrest or incarceration are a vulnerable population that present a unique ethical and logistical challenge for emergency physicians (EPs). People incarcerated in the United States have a constitutional right to health care. When caring for these patients, EPs must balance their ethical obligations to the patient with security and safety concerns. They should refer to their institutional policy for guidance and their local, state, and federal laws, when applicable. Hospital legal counsel and risk management also can be helpful resources. EPs should communicate early and openly with law enforcement personnel to ensure security and emergency department staff safety is maintained while meeting the patient's medical needs. Physicians should consider the least restrictive restraints necessary to ensure security while allowing for medical evaluation and treatment. They should also protect patient privacy as much as possible within departmental constraints, promote the patient's autonomous medical decision-making, and be mindful of ways that medical information could interact with the legal system.
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Affiliation(s)
- Samantha Chao
- Department of Emergency MedicineMichigan MedicineAnn ArborMichiganUSA
| | - William Weber
- Department of Emergency MedicineRush UniversityChicagoIllinoisUSA
| | - Kenneth V. Iserson
- Department of Emergency MedicineThe University of ArizonaTucsonArizonaUSA
| | - Rebecca Goett
- Department of Emergency MedicineRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | | | | | - Paul Bissmeyer
- Department of Emergency MedicineOrange Park HospitalJacksonvilleFloridaUSA
| | - Arthur R. Derse
- Center for Bioethics and Medical Humanities and Department of Emergency MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Nishi Kumar
- College of LawLoyola University New OrleansNew OrleansLouisianaUSA
| | - Jay M. Brenner
- Department of Emergency MedicineSUNY‐Upstate Medical UniversitySyracuseNew YorkUSA
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Gagliardi JP, Smith CM, Chang-Sing EJK, Cramer LD, Robinson L, Shah D, Jivalagian PA, Turner NA, Wong AH. Racial Inequities in Police Transport for Patients to the Emergency Department: A Multicenter Analysis. Am J Prev Med 2024; 66:154-158. [PMID: 37661074 PMCID: PMC10842350 DOI: 10.1016/j.amepre.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Police involvement in patient transport to emergency medical care has increased over time, yet studies assessing racial inequities in transport are limited. This study evaluated the relationship between race and police transport to the emergency department for adult patients. METHODS This cross-sectional study evaluated adult (aged ≥18 years) visits at 13 different emergency departments across two regional hospital systems in the Southeastern and Northeastern U.S. from 2015 to 2022. Data were extracted from electronic health records. This analysis evaluated the association between race and transport by police transport using generalized linear multivariable mixed model with a binary logistic link for presence of police transport. Data were nested by patient and adjusted for site, demographics, and diagnostic visit characteristics. RESULTS Of 4,291,809 adult emergency department visits, 25,901 (0.6%) involved transport by police. Of the 25,901 visits in police-involved encounters, 10,513 (40.6%) patients were Black, and 9,827 (37.9%) were White. The adjusted model showed that Black patients were at higher odds of transport by police than White patients (AOR=1.64; 95% CI=1.57-1.72). Male sex, younger age (18-35 years), history of behavioral health diagnosis, and emergency department psychiatric or substance use disorders were independently associated with increased odds of police transport. CONCLUSIONS This analysis revealed racial inequities in police-involved transport to emergency medical care, highlighting an urgent need to evaluate drivers of inequities and the ways in which police transport influences clinical outcomes.
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Affiliation(s)
- Jane P Gagliardi
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Colin M Smith
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | | | - Laura D Cramer
- Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Leah Robinson
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dhruvil Shah
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Pateel A Jivalagian
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nicholas A Turner
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Schenck CS, Dodington J, Paredes L, Gawel M, Nedd A, Vega P, O’Neill KM. Implementation of an emerging hospital-based violence intervention program: a multimethod study. Trauma Surg Acute Care Open 2023; 8:e001120. [PMID: 38020854 PMCID: PMC10660964 DOI: 10.1136/tsaco-2023-001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Individuals who experience assaultive firearm injury are at elevated risk for violent reinjury and multiple negative physical and psychological health outcomes. Hospital-based violence intervention programs (HVIPs) may improve patient outcomes through intensive, community-based case management. Methods We conducted a multimethod evaluation of an emerging HVIP at a large trauma center using the RE-AIM framework. We assessed recruitment, violent reinjury outcomes, and service provision from 2020 to 2022. Semistructured, qualitative interviews were performed with HVIP participants and program administrators to elicit experiences with HVIP services. Directed content analysis was used to generate and organize codes from the data. We also conducted clinician surveys to assess awareness and referral patterns. Results Of the 319 HVIP-eligible individuals who presented with non-fatal assaultive firearm injury, 39 individuals (12%) were enrolled in the HVIP. Inpatient admission was independently associated with HVIP enrollment (OR 2.6, 95% CI 1.3 to 5.2; p=0.01). Facilitators of Reach included engaging with credible messengers, personal relationships with HVIP program administrators, and encouragement from family to enroll. Fear of disclosure to police was cited as a key barrier to enrollment. For the Effectiveness domain, enrollment was not associated with reinjury (OR 0.70, 95% CI 0.16 to 3.1). Participants identified key areas of focus where needs were not met including housing and mental health. Limited awareness of HVIP services was a barrier to Adoption. Participants described strengths of Implementation, highlighting the deep relationships built between clients and administrators. For the long-term Maintenance of the program, both clinicians and HVIP clients reported that there is a need for HVIP services for individuals who experience violent injury. Conclusions Credible messengers facilitate engagement with potential participants, whereas concerns around police involvement is an important barrier. Inpatient admission provides an opportunity to engage patients and may facilitate recruitment. HVIPs may benefit from increased program intensity. Level of evidence IV.
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Affiliation(s)
| | - James Dodington
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lucero Paredes
- Department of Surgery, Maine Medical Center, Portland, Maine, USA
| | - Marcie Gawel
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Antwan Nedd
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Pepe Vega
- Center for Injury & Violence Prevention, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Kathleen M O’Neill
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Kaiksow FA, Williams BA, Haber LA. Hospitalized While Incarcerated: Incarceration-Specific Care Practices. Ann Intern Med 2023; 176:1540-1541. [PMID: 37871315 PMCID: PMC10962278 DOI: 10.7326/m23-1873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Affiliation(s)
- Farah Acher Kaiksow
- Division of Hospital Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (F.A.K.)
| | - Brie A Williams
- Priscilla Chan and Mark Zuckerberg San Francisco General Hospital & Trauma Center, The Center for Vulnerable Populations, University of California San Francisco, San Francisco, California (B.A.W.)
| | - Lawrence A Haber
- Division of Hospital Medicine, Denver Health and Hospital Authority, Department of Medicine, University of Colorado, Denver, Colorado (L.A.H.)
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Lamneck C, Alvarez A, Zaragoza C, Rahimian R, Trejo MJ, Lebensohn P. Assessment of immigration law enforcement presence in a teaching hospital along the US/Mexico border. Int J Equity Health 2023; 22:199. [PMID: 37770859 PMCID: PMC10540385 DOI: 10.1186/s12939-023-01934-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/13/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Over the past decade, the United States (US) has seen a spike in migration across the US-Mexico border with an increase in hospital admissions of migrants and asylum-seekers under the custody of immigration law enforcement (ILE). This study aimed to determine how the presence of ILE officials affects patient care and provider experience in a teaching hospital setting. METHODS This cross-sectional online survey solicited quantitative and qualitative feedback from medical students, residents, and attending physicians (n = 1364) at a teaching hospital system with two campuses in Arizona. The survey included participant demographics and addressed participants' experience caring for patients in ILE custody, including the perception of respect, violations of patients' privacy and autonomy, and the comfort level with understanding hospital policies and patient rights. Thematic analyses were also performed based on respondent comments. RESULTS 332 individuals (24%) responded to the survey. Quantitative analyses revealed that 14% of participants described disrespectful behaviors of ILE officials, mainly toward detained patients. Qualitative thematic analyses of respondent comments revealed details on such disrespectful encounters including ILE officers violating the Health Insurance Portability and Accountability Act (HIPAA) and using intimidation tactics with patients. Nearly half of the respondents did not have knowledge of policies about ILE detainees' medical care, detainees' privacy rights, or ILE's authority in patient care. CONCLUSIONS This study points out the complexities, challenges, and ethical considerations of caring for patients in ILE custody in the hospital setting and the need to educate healthcare professionals on both patient and provider rights. It describes the lived experiences and difficulties that providers on the border face in trying to achieve equity in the care they provide to detained migrant patients.
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Affiliation(s)
- Claire Lamneck
- University of Arizona College of Medicine, Tucson, AZ, USA
| | | | | | | | - Mario Jesus Trejo
- University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
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Wardrop R, Ranse J, Chaboyer W, Crilly J. Characteristics and outcomes of patient presentations to the emergency department via police: A scoping review. Australas Emerg Care 2023; 26:239-248. [PMID: 36792389 DOI: 10.1016/j.auec.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND As emergency department (ED) presentations continue to rise, understanding the complexities of vulnerable populations such as people brought in by police (BIBP) is crucial. This review aimed to map and describe the research about people BIBP to the ED. DESIGN AND METHOD A scoping review, guided by the Joanna Briggs Institute process, was undertaken. The databases CINAHL, Embase and PubMed were searched between November 2017 and July 2022. The Patterns, Advances, Gaps, Evidence for practice, Research recommendations (PAGER) framework was used to guide the analysis. RESULTS A total of 21 studies were included in the review, originating mainly from westernised countries. Examination of patterns across studies revealed four themes: routinely collected data is used to describe people BIBP to the ED; a focus on mental health care; the relationship between care delivery and outcomes; and the role of police in providing emergency care. CONCLUSION There is some understanding of the demographic characteristics, clinical characteristics, and outcomes of people BIBP to the ED. Knowledge gaps surrounding sociodemographic factors, prehospital and ED care delivery for people BIBP require further investigation to optimise outcomes for this vulnerable cohort of presenters.
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Affiliation(s)
- Rachel Wardrop
- School of Nursing and Midwifery, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Dr, Southport, QLD 4222, Australia.
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Dr, Southport, QLD 4222, Australia.
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
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12
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Ray K, Fletcher FE, Martschenko DO, James JE. Black Bioethics in the Age of Black Lives Matter. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:251-267. [PMID: 36752936 PMCID: PMC9905759 DOI: 10.1007/s10912-023-09783-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Keisha Ray
- McGovern Medical School, University of Texas Health Science Center, Jesse Jones Library 450, Houston, TX USA
| | - Faith E. Fletcher
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX USA
| | - Daphne O. Martschenko
- Stanford Center for Biomedical Ethics and Department of Pediatrics, Stanford University, Stanford, CA USA
| | - Jennifer E. James
- Department of Social & Behavioral Sciences, and UCSF Bioethics, University of California, San Francisco, CA USA
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13
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Schultz ML, Winn M, Derse AR, Kaczor F, Levas MN. Interactions With Police in the Emergency Care of Children: Ethical and Legal Considerations. Pediatr Emerg Care 2023; 39:226-229. [PMID: 36727807 PMCID: PMC10082052 DOI: 10.1097/pec.0000000000002908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Emergency medicine providers may interface with law enforcement personnel (LEP) on behalf of their pediatric patients for a variety of reasons, from reporting child abuse to caring for children who are in police custody. Given the unique nature of caring for minors who may not have legal or medical autonomy, interactions with LEP can raise ethical concerns for emergency providers, specifically with regard to legal representation, developmental immaturity, and the civil rights of children and their parents/guardians. METHODS We review 4 patient scenarios, based on real cases experienced by the authors, to demonstrate the legal and ethical issues that may arise when LEP are involved in the emergency care of a child. These scenarios discuss parental/guardian visitation for children in police custody in the emergency department (ED), the practice of making arrests on hospital grounds, and police interviews of children in the ED. RESULTS Using the ethical principles of autonomy, beneficence, and justice, we offer recommendations for emergency providers on how to advocate for their pediatric patients in LEP custody within the constraints and protections of the law. We also suggest best practices for hospital systems to develop policies surrounding LEP activity in the ED. CONCLUSIONS These nuanced situations require careful advocacy for the child and a collaborative approach between medical providers and LEP to balance the child's well-being with public safety. We offer recommendations here, and we maintain that clear, widely adopted best practices for the care of minors in LEP custody are long overdue.
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Affiliation(s)
- Megan L. Schultz
- From the Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin
| | - Madeline Winn
- From the Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin
| | - Arthur R. Derse
- Department of Emergency Medicine, Medical College of Wisconsin
| | | | - Michael N. Levas
- From the Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin
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14
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Gallen K, Sonnenberg J, Loughran C, Smith MJ, Sheppard M, Schuster K, Kaufman E, Song JS, Hall EC. Health Effects of Policing in Hospitals: a Narrative Review. J Racial Ethn Health Disparities 2023; 10:870-882. [PMID: 35267188 DOI: 10.1007/s40615-022-01275-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Law enforcement activity, in the form of outside agencies or hospital security forces, is increasingly common in American healthcare. Little is known about the potential effects of this prevalent, modifiable exposure on hospital staff and patient health. This narrative review characterizes existing evidence on the direct and indirect health effects of law enforcement activity in hospitals. OBSERVATIONS Law enforcement activity in hospitals can affect health outcomes through four mechanisms: (1) physical health effects related to workplace violence, restraint use, excessive force, and weapon use; (2) mental health effects involving perceptions of safety and psychological distress; (3) social effects related to the patient-provider relationship, mistrust, and bias and discrimination; and (4) legal and ethical considerations affecting overall well-being. CONCLUSIONS AND RELEVANCE Unchecked law enforcement activity in hospitals may risk patient physical and mental health, reduce patient trust, result in bias and discrimination, and contribute to legal and ethical rights violations. Importantly, law enforcement activity in hospitals may also contribute to staff perceptions of safety. To fill knowledge gaps on the measurable impact of law enforcement activity in the hospital on staff and patients, hospitals should collect and publicly share robust data on law enforcement activity in their facilities, create and adopt patient-centered policies to ensure safety and protect patient health and privacy, and implement evidence-based interventions that safely reduce law enforcement involvement with patients.
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Affiliation(s)
- Kate Gallen
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Jake Sonnenberg
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | | | - Mildred Sheppard
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - Kirsten Schuster
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Elinore Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ji Seon Song
- School of Law, University of California, Irvine, CA, USA
| | - Erin C Hall
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, DC, 20010, USA.
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15
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Kaufman EJ, Khatri U, Hall EC, Alur R, Song J, Beard JH, Jacoby SF. Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma. Trauma Surg Acute Care Open 2023; 8:e001022. [PMID: 36937171 PMCID: PMC10016311 DOI: 10.1136/tsaco-2022-001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/20/2023] [Indexed: 03/14/2023] Open
Abstract
Background Trauma patients frequently come into contact with law enforcement officers (LEOs) during the course of their medical care, but little is known about how LEO presence affects processes of care. We surveyed members of the American Association for the Surgery of Trauma (AAST) to assess their perspectives on frequency, circumstances, and implications of LEO presence in trauma bays nationwide. Methods Survey items addressed respondents' experience with the frequency and context of LEO presence and their perspectives on the impact of LEO presence for patients, clinical care, and public safety. Respondent demographics, professional characteristics, and practice setting were collected. The survey was distributed electronically to AAST members in September and October of 2020. Responses were compared by participant age, gender, race, ethnicity, urban versus rural location using χ2 tests. Results Of 234 respondents, 189 (80.7%) were attending surgeons, 169 (72.2%) identified as white, and 144 (61.5%) as male. 187 respondents (79.9%) observed LEO presence at least weekly. Respondents found LEO presence was most helpful for public safety, followed by clinical care, and then for patients. Older respondents rated LEO presence as helpful more often than younger respondents regarding the impact on patients, clinical care, and public safety (p<0.001 across all domains). When determining LEO access, respondents assessed severity of the patient's condition, the safety of emergency department staff, the safety of LEOs, and a patient's potential role as a threat to public safety. Conclusions Respondents described a wide range of perspectives on the impact and consequence of LEO in the trauma bay, with little policy to guide interactions. The overlap of law enforcement and healthcare in the trauma bay deserves attention from institutional and professional policymakers to preserve patient safety and autonomy and patient-centered care. Level of evidence IV, survey study.
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Affiliation(s)
- Elinore J Kaufman
- Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Utsha Khatri
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Erin C Hall
- Department of Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Rucha Alur
- Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jamie Song
- Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jessica H Beard
- Division of Trauma Surgery and Surgical Critical Care, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sara F Jacoby
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Khatri U, Kaufman E, Seeburger E, Alur R, Richardson L, South E, Jacoby S. Emergency Physician Observations and Attitudes on Law Enforcement Activities in the Emergency Department. West J Emerg Med 2023; 24:160-168. [PMID: 36976602 PMCID: PMC10047729 DOI: 10.5811/westjem.2022.12.57098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/15/2022] [Indexed: 03/20/2023] Open
Abstract
Introduction: Law enforcement officers (LEO) interact with patients and clinicians in the emergency department (ED) for many reasons. There is no current consensus on what should comprise, or how to best enact, guidelines that ideally balance LEO activities in the service of public safety with patient health, autonomy, and privacy. The purpose of this study was to explore how a national sample of emergency physicians (EP) perceives activities of LEOs during the delivery of emergency medical care.
Methods: Members of the Emergency Medicine Practice Research Network (EMPRN) were recruited via an email-delivered, anonymous survey that elicited experiences, perceptions, and knowledge of policies that guide interactions with LEOs in the ED. The survey included multiple-choice items, which we analyzed descriptively, and open-ended questions, which we analyzed using qualitative content analysis.
Results: Of 765 EPs in the EMPRN, 141 (18.4%) completed the survey. Respondents represented diverse locations and years in practice. A total of 113 (82%) respondents were White, and 114 (81%) were male. Over a third reported LEO presence in the ED on a daily basis. A majority (62%) perceived LEO presence as helpful for clinicians and clinical practice. When asked about the factors deemed highly important in allowing LEOs to access patients during care, 75% reported patients’ potential as a threat to public safety. A small minority of respondents (12%) considered the patients’ consent
or preference to interact with LEOs. While 86% of EPs felt that information-gathering by LEO was appropriate in the ED setting, only 13% were aware of policy to guide these decisions. Perceived barriers to implementation of policy in this area included: issues of enforcement; leadership; education; operational challenges; and potential negative consequences.
Conclusion: Future research is warranted to explore how policies and practices that guide intersections between emergency medical care and law enforcement impact patients, clinicians, and the communities that health systems serve.
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Affiliation(s)
- Utsha Khatri
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York; Icahn School of Medicine at Mount Sinai, Institute for Health Equity Research, Department of Population Health Science and Policy, New York, New York
| | - Elinore Kaufman
- University of Pennsylvania Perelman School of Medicine, Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Philadelphia, Pennsylvania
| | - Emily Seeburger
- Perelman School of Medicine at the University of Pennsylvania, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Rucha Alur
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lynne Richardson
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York; Icahn School of Medicine at Mount Sinai, Institute for Health Equity Research, Department of Population Health Science and Policy, New York, New York
| | - Eugenia South
- Perelman School of Medicine at the University of Pennsylvania, Penn Urban Health Lab, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Sara Jacoby
- University of Pennsylvania School of Nursing, Department of Family and Community Health, Philadelphia, Pennsylvania
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17
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Walk the line: An ethical framework for interactions with law enforcement in trauma care environments. J Trauma Acute Care Surg 2023; 94:e20-e22. [PMID: 36253908 DOI: 10.1097/ta.0000000000003810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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18
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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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Samuels-Kalow ME, Agrawal P, Rodriguez G, Zeidan A, Love JS, Monette D, Lin M, Cooper RJ, Madsen TE, Dobiesz V. Post-Roe emergency medicine: Policy, clinical, training, and individual implications for emergency clinicians. Acad Emerg Med 2022; 29:1414-1421. [PMID: 36268814 PMCID: PMC9772035 DOI: 10.1111/acem.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 12/24/2022]
Abstract
In June 2022, the United States Supreme Court decision Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade, removing almost 50 years of precedent and enabling the imposition of a wide range of state-level restrictions on abortion access. Historical data from the United States and internationally demonstrate that the removal of safe abortion options will increase complications and the health risks to pregnant patients. Because the emergency department is a critical access point for reproductive health care, emergency clinicians must be prepared for the policy, clinical, educational, and legal implications of this change. The goal of this paper, therefore, is to describe the impact of the reversal of Roe v. Wade on health equity and reproductive justice, the provision of emergency care education and training, and the specific legal and reproductive consequences for emergency clinicians. Finally, we conclude with specific recommended policy and advocacy responses for emergency medicine clinicians.
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Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Giovanni Rodriguez
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Zeidan
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer S Love
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Derek Monette
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Lin
- Department of Emergency Medicine, Stanford University, Palo Alto, California, USA
| | - Richelle J Cooper
- Department of Emergency Medicine, University of California Los Angeles, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Tracy E Madsen
- Department of Emergency Medicine, Alpert Medial School of Brown University, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Valerie Dobiesz
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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20
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Alur R, Hall E, Khatri U, Jacoby S, South E, Kaufman EJ. Law Enforcement in the Emergency Department. JAMA Surg 2022; 157:852-854. [PMID: 35857315 DOI: 10.1001/jamasurg.2022.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rucha Alur
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Erin Hall
- Surgical Intensive Care Unit, MedStar Washington Hospital Center, Washington, DC
| | - Utsha Khatri
- Emergency Medicine, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Sara Jacoby
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia
| | - Eugenia South
- Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadephia
| | - Elinore J Kaufman
- Traumatology, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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21
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Wardrop R, Ranse J, Chaboyer W, Crilly J. Profile and outcomes of emergency department presentations based on mode of arrival: A state-wide retrospective cohort study. Emerg Med Australas 2021; 34:519-527. [PMID: 34908237 DOI: 10.1111/1742-6723.13914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Understanding how people arrive to the ED assists in planning health services' response to fluctuating ED demand. The present study aimed to describe and compare demographics, clinical characteristics and health service outcomes of adult ED patient presentations based on mode of arrival: brought in by police (BIBP)/brought in by ambulance (BIBA)/privately arranged transport (PAT). METHODS A retrospective cohort study of ED patient presentations made between 1 January 2018 and 31 December 2020 from all public hospital EDs across Queensland, Australia. Descriptive and inferential analyses were performed to ascertain presentation characteristics and predictors of health service outcomes. RESULTS From 4 707 959 ED presentations, 0.9% were BIBP, 34.8% were BIBA and 64.0% were PAT. Presentations BIBP were younger and comprised a higher proportion of mental health problems and Emergency Examination Authority orders compared to presentations BIBA or PAT. Compared to presentations BIBP or PAT, presentations BIBA were more likely to be assigned more urgent triage scores, be admitted to hospital, and have a longer ED length of stay (LOS). Compared to other modes of arrival, presentations arriving by PAT were more likely to be discharged and have a shorter ED LOS. CONCLUSION Presentations BIBA and BIBP encountered a longer ED LOS and higher admission rates than PAT, suggesting more complex care needs than those from PAT. Clinical care pathways for specific modes of arrival that support pre-hospital providers and patients and are considerate of the throughput and output stages of ED care may be needed.
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Affiliation(s)
- Rachel Wardrop
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
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