Building an ethical environment improves patient privacy and satisfaction in the crowded emergency department: a quasi-experimental study

BMC Medical Ethics

Tsung-Ying Lin²  Chao-Wen Chen²  Hsing-Lin Lin²  Chia-Ju Lin¹  Yuan-Chia Cheng²  Liang-Chi Kuo²  Wei-Che Lee²  Yen-Ko Lin² 

[1] College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan;Division of Traumatology, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

关键词: Emergency Department;    Satisfaction;    Confidentiality;    Privacy;    Ethical environment;   

Others  :  799982
DOI  :  10.1186/1472-6939-14-8

 received in 2012-08-13, accepted in 2013-02-06,  发布年份 2013

【 摘 要 】

Background

To evaluate the effectiveness of a multifaceted intervention in improving emergency department (ED) patient privacy and satisfaction in the crowded ED setting.

Methods

A pre- and post-intervention study was conducted. A multifaceted intervention was implemented in a university-affiliated hospital ED. The intervention developed strategies to improve ED patient privacy and satisfaction, including redesigning the ED environment, process management, access control, and staff education and training, and encouraging ethics consultation. The effectiveness of the intervention was evaluated using patient surveys. Eligibility data were collected after the intervention and compared to data collected before the intervention. Differences in patient satisfaction and patient perception of privacy were adjusted for predefined covariates using multivariable ordinal logistic regression.

Results

Structured questionnaires were collected with 313 ED patients before the intervention and 341 ED patients after the intervention. There were no important covariate differences, except for treatment area, between the two groups. Significant improvements were observed in patient perception of “personal information overheard by others”, being “seen by irrelevant persons”, having “unintentionally heard inappropriate conversations from healthcare providers”, and experiencing “providers’ respect for my privacy”. There was significant improvement in patient overall perception of privacy and satisfaction. There were statistically significant correlations between the intervention and patient overall perception of privacy and satisfaction on multivariable analysis.

Conclusions

Significant improvements were achieved with an intervention. Patients perceived significantly more privacy and satisfaction in ED care after the intervention. We believe that these improvements were the result of major philosophical, administrative, and operational changes aimed at respecting both patient privacy and satisfaction.

【 授权许可】

   
2013 Lin et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Karro J, Dent AW, Farish S: Patient perceptions of privacy infringements in an emergency department. Emerg Med Australas 2005, 17(2):117-123.
• [2]Moskop JC, Marco CA, Larkin GL, Geiderman JM, Derse AR: From Hippocrates to HIPAA: privacy and confidentiality in emergency medicine–Part I: conceptual, moral, and legal foundations. Ann Emerg Med 2005, 45(1):53-59.
• [3]Geiderman JM, Moskop JC, Derse AR: Privacy and confidentiality in emergency medicine: obligations and challenges. Emerg Med Clin North Am 2006, 24(3):633-656.
• [4]Mlinek EJ, Pierce J: Confidentiality and privacy breaches in a university hospital emergency department. Acad Emerg Med 1997, 4(12):1142-1146.
• [5]Moskop JC, Sklar DP, Geiderman JM, Schears RM, Bookman KJ: Emergency Department Crowding, Part 1–Concept, Causes, and Moral Consequences. Ann Emerg Med 2009, 53(5):605-611.
• [6]Higginson I: Emergency department crowding. Emerg Med J 2012, 29(6):437-443.
• [7]Pines JM, McCarthy ML: Executive Summary: Interventions to Improve Quality in the Crowded Emergency Department. Acad Emerg Med 2011, 18(12):1229-1233.
• [8]Olsen JC, Cutcliffe B, O'Brien BC: Emergency Department Design and Patient Perceptions of Privacy and Confidentiality. J Emerg Med 2008, 35(3):317-320.
• [9]Morris ZS, Boyle A, Beniuk K, Robinson S: Emergency department crowding: towards an agenda for evidence-based intervention. Emerg Med J 2012, 29(6):460-466.
• [10]McDaniel C, Veledar E, LeConte S, Peltier S, Maciuba A: Ethical Environment, Healthcare Work, and Patient Outcomes. Am J Bioeth 2006, 6(5):W17-W29.
• [11]Joseph J, Deshpande SP: The Impact of Ethical Climate on Job Satisfaction of Nurses. Health Care Manage Rev 1997, 22(1):76-81.
• [12]Shortell SM, Zimmerman JE, Rousseau DM, Gillies RR, Wagner DP, Draper EA, Knaus WA, Duffy J: The Performance of Intensive Care Units: Does Good Management Make a Difference? Medical Care 1994, 32(5):508-525.
• [13]Hart SE: Hospital Ethical Climates and Registered Nurses' Turnover Intentions. J Nurs Scholarsh 2005, 37(2):173-177.
• [14]Ulrich C, O’Donnell P, Taylor C, Farrar A, Danis M, Grady C: Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Soc Sci Med 2007, 65(8):1708-1719.
• [15]Shirey MR: Ethical Climate in Nursing Practice: The Leader's Role. JONAS Healthc Law Ethics Regul 2005, 7(2):59-67.
• [16]Bell J, Breslin J: Healthcare provider moral distress as a leadership challenge. JONAS Healthc Law Ethics Regul 2008, 10(4):94-97.
• [17]Allen AL: Genetic Privacy: Emerging Concepts and Values. In Genetic Secrets: Protecting Privacy and Confidentiality in the Genetic Era. Edited by Rothstein MA. New Haven, CT: Yale University Press; 1997:31-59.
• [18]Olsen JC, Sabin BR: Emergency Department patient perceptions of privacy and confidentiality. J Emerg Med 2003, 25(3):329-333.
• [19]Barlas D, Sama AE, Ward MF, Lesser ML: Comparison of the auditory and visual privacy of emergency department treatment areas with curtains versus those with solid walls. Ann Emerg Med 2001, 38(2):135-139.
• [20]Beauchamp TL, Childress JF: Professional-Patient Relationships. In Principles of Biomedical Ethics. Fifth edition. New York: Oxford University Press, Inc; 2001:293-312.
• [21]Lin Y-K, Lin C-J: Factors predicting patients' perception of privacy and satisfaction for emergency care. Emerg Med J 2011, 28(7):604-608.
• [22]Elger BS: Factors influencing attitudes towards medical confidentiality among Swiss physicians. J Med Ethics 2009, 35(8):517-524.
• [23]Sohrabia M-R, Alimohammadib H: Privacy, Confidentiality and Facility Criteria in Designing Emergency Departments of the Teaching Hospitals of Shahid Beheshti University of Medical Sciences in 2007. J Res Health Sci 2010, 10(1):36-41.
• [24]Lovato E, Minniti D, Giacometti M, Sacco R, Piolatto A, Barberis B, Papalia R, Bert F, Siliquini R: Humanisation in the emergency department of an Italian hospital: new features and patient satisfaction. Emerg Med J 2012, Jul 3:Jul 3. Jul 3
• [25]Humayun A, Fatima N, Naqqash S, Hussain S, Rasheed A, Imtiaz H, Imam S: Patients' perception and actual practice of informed consent, privacy and confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore. BMC Med Ethics 2008, 9(1):14. BioMed Central Full Text
• [26]Nayeri ND, Aghajani M: Patients' privacy and satisfaction in the emergency department: a descriptive analytical study. Nurs Ethics 2010, 17(2):167-177.
• [27]Moskop JC, Sklar DP, Geiderman JM, Schears RM, Bookman KJ: Emergency Department Crowding, Part 2–Barriers to Reform and Strategies to Overcome Them. Ann Emerg Med 2009, 53(5):612-617.
• [28]Oredsson S, Jonsson H, Rognes J, Lind L, Goransson K, Ehrenberg A, Asplund K, Castren M, Farrohknia N: A systematic review of triage-related interventions to improve patient flow in emergency departments. Scand J Trauma Resusc Emerg Med 2011, 19(1):43. BioMed Central Full Text
• [29]Hoot NR, Aronsky D: Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions. Ann Emerg Med 2008, 52(2):126-136. e121
• [30]Forero R, McCarthy S, Hillman K: Access block and emergency department overcrowding. Crit Care 2011, 15(2):216. BioMed Central Full Text
• [31]Cowan R, Trzeciak S: Clinical review: Emergency department overcrowding and the potential impact on the critically ill. Crit Care 2005, 9(3):291-295. BioMed Central Full Text
• [32]Farrokhnia N, Göransson KE: Swedish emergency department triage and interventions for improved patient flows: a national update. Scand J Trauma Resusc Emerg Med 2011, 19:72. BioMed Central Full Text
• [33]Pham JC, Seth Trueger N, Hilton J, Khare RK, Smith JP, Bernstein SL: Interventions to Improve Patient-centered Care During Times of Emergency Department Crowding. Acad Emerg Med 2011, 18(12):1289-1294.
• [34]Eccles M, Grimshaw J, Campbell M, Ramsay C: Research designs for studies evaluating the effectiveness of change and improvement strategies. Qual Saf Health Care 2003, 12(1):47-52.