Patient confidentiality in emergency department

1. Patient confidentiality in the ED

3. 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.

4. 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

5. 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?

6. 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.

7. 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

8. 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

9. 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

12. 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.)

13. 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

14. 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.

15. 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

16. Who should you always notify
 Duty consultant
 Head of department
 DEMT

17. 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.”

18. 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.

19. 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.

20. 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.

21. Who can you ask for advice

22. 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