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Patient confidentiality in emergency department


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Patient confidentiality in emergency department

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Patient confidentiality in emergency department

  1. 1. Patient confidentiality in the ED
  2. 2. What is confidentiality? the non-disclosure of all information that comes to a health practitioner in the course of their relationship with patients. This includes that a health professional (or anyone else who comes into contact with that information – such as administrative staff) must not disclose information to other individuals, the public or organisations.
  3. 3. 52 M Duty Anaesthetist / called in for urgent case in OT Palpitations for the last 2 hours - HR 140/min; ECG - AF + fast ventricular response • If needs cardioversion – who will do it? Who will sedate him? • After-hours nurse manager comes by to ask about his condition as she’s worried in case he’s needed for another urgent case
  4. 4. 29 F P1 OD – quetiapine, alprazolam, venlafaxine “She works as a doctor here” Oncall Reg for Renal from 5 pm • GCS 13, anticholinergic / for observation in ED. What privacy issues do you face? • She is rostered to be oncall in 2 hours. What do you do?
  5. 5. 63 F member of North Metro Board Brought in with S/ ICH on CT GCS 7 • SCGH director of nursing and director of medical division come in to “check on her” and ask about her clinical state.
  6. 6. 52 M country GP Cardiac arrest on way to remote clinic, downtime 72 min • Phone call from hospital Consultant that you know asking about his state as they’re good friends
  7. 7. 18 M son of director of surgical division Brought in by police and ambulance with amphetamine induced agitated delirium • Clinical director of hospital comes in to see how he’s going / would like more details
  8. 8. 21M brought in by police agitated after being involved in high speed MVA on freeway during police chase • Police officer calls you to ask for details about injuries as they need to provide a preliminary report
  9. 9. VIPs in the department: some basic rules • Duty Consultant should be at least aware about them if not directly involved in care • Provide medical care as for any other patient • Maintain privacy – Access limited to practitioners with a "need-to-know" status (eg treating doctors, nurses, allied health etc.)
  10. 10. VIPs in the department: some basic rules • Respect confidentiality – if treating doctor – for those who are not your patients • Do NOT give any information over the phone • Check if person listed as NOK is the actual NOK / can give consent
  11. 11. Mandatory notifications AHPRA ‘Notifiable conduct” under legislation: • practised while intoxicated by alcohol or drugs or • engaged in sexual misconduct in connection with their practice or • placed the public at risk of substantial harm in their practice because the practitioner has an impairment or • placed the public at risk of harm because they have practised in a way that constitutes a significant departure from accepted professional standards.
  12. 12. Mandatory notifications AHPRA  includes students who are impaired and are engaged in clinical training as part of their course. “A “reasonable belief” should not be based on speculation, gossip, rumour or innuendo.”  The WA treating practitioner exemption: in WA you are not obliged to notify AHPRA if you form your belief about the notifiable conduct in the course of providing health services to the practitioner
  13. 13. Who should you always notify  Duty consultant  Head of department  DEMT
  14. 14. When can you disclose medical information about a patient without written consent • There is a serious and imminent threat of harm to the patient or another identifiable person or group of persons “A doctor may disclose information from a patient’s medical record without consent if the doctor reasonably believes the patient may cause imminent and serious harm to themselves, an identifiable individual or group of persons. In such circumstances, disclosure may be necessary to lessen or prevent a serious and imminent threat to an individual’s life, health, safety, or welfare or a serious threat to public health, public safety or public welfare.”
  15. 15. When can you disclose medical information about a patient without written consent • In a medical emergency • Health service management activities and processes: complaints handling; audit and quality assurance; funding; accreditation; incident monitoring; obtaining medico-legal opinions; insurance; and medical indemnity organisations.
  16. 16. When can you disclose medical information about a patient without written consent • By statute, warrant, subpoena, or court order: – By statute: mandatory disease notification or mandatory notification of child abuse; Firearms Act 1973 – Warrant, subpoena, or court order requiring the doctor to produce a patient’s medical record, some doctors may wish to oppose disclosure of clinically sensitive or potentially harmful information. The records should still be supplied but under seal, asking that the court not release the records to the parties until it has heard argument against disclosure.
  17. 17. What can happen if you breach a patient’s confidentiality? • Disciplinary action by the employer of the person who made the disclosure. • Legal action claiming damages (compensation) against the person who made the disclosure and/or his or her employer. • Disciplinary proceedings under the health professional’s regulatory statute. • The imposition of a fine or other penalty when there is a contravention of a statutory duty of confidence.
  18. 18. Who can you ask for advice
  19. 19. Who can you ask for advice  Duty consultant  Head of department  DEMT  Professional indemnity organisation  Medical administration (Legal & legislative services) hospital / WA State Solicitor  AMA