Background Patient privacy and confidentiality (PPaC) is an important consideration for nurses and other members of the health care team. Can a patient expect to have confidentiality and in particular privacy in the current climate of emergency health care? Do staff who work in the Emergency Department (ED) see confidentiality as an important factor when providing emergency care? These questions are important to consider. Methods This is a two phased quality improvement project, developed and implemented over a six month period in a busy regional, tertiary referral ED. Results Issues identified for this department included department design and layout, overcrowding due to patient flow and access block, staff practices and department policies which were also impacted upon by culture of the team, and use of space. Conclusions Changes successful in improving this issue include increased staff awareness about PPaC, intercom paging prior to nursing handover to remove visitors during handover, one visitor per patient policy, designated places for handover, allocated bed space for patient reviews/assessment and a strategy to temporarily move the patient if procedures would have been undertaken in shared bed space. These are important issues when considering policy, practice and department design in the ED.

We report the isolation of a genomic clone containing the apolipoprotein CII (apo CII) gene and 5' and 3' flanking sequences. A detailed restriction map of the gene has been constructed and DNA fragments that are unique, or low copy number sequences in the genome have been identified. One of these detects a common restriction fragment length polymorphism (RFLP) with the enzyme BglI. Marked linkage disequilibrium is observed between this RFLP and that detected with the apo CII cDNA clone, even though the two variable restriction enzyme sites are approximately 12kb apart. However, the usefulness of the apo CII gene as a marker for linkage studies is increased by the use of both RFLPs.

AimsTo assess the value added to patient care by the input of the paediatrician following referral to a general paediatric outpatient department.MethodsThe authors received 200 general practitioner (GP) referral letters from the Primary Care Trust (PCT) over a 2-year period. The authors excluded letters to other hospitals and to non-medical specialties, such as paediatric surgery or ENT. A group of paediatricians reviewed both the referral letter and the return correspondence, and made a judgement on the relevance of the referral to hospital.Results70 pairs of letters were analysed. In 45, patient care was improved by referral to secondary care. In 25 it was felt the referral could have been avoided.The referrals which enhanced patient care: ▸ suspicion of serious underlying conditions▸ unclear diagnosis▸ treatment instituted by GP had not resolved the problem▸ further hospital investigation and management required However, there were instances in which improvements could be made: ▸ lack of information on the referral▸ incorrect diagnosis on the letter▸ referral being directed towards the wrong individual Other letters highlighted education and training issues: ▸ knowledge or confidence gap in the GPs' training▸ lack of confidence in treating children▸ lack of confidence by the GP in his own diagnosis This carries a cost implication—if 36% of the 1268 referrals to general paediatrics last year were potentially avoidable, this would represent a saving to the PCT of £110 000.ConclusionsThe authors advocate an integrated approach to healthcare for children in which GPs have easy and ready access to advice from paediatricians. There is a shortage of paediatric resources, partly due to different working patterns after the introduction of the European Working Time Directive. We must ensure the most appropriate use of scarce resources. With improved communication, the numbers of children requiring hospital review can be reduced. The authors feel that better links between primary and secondary care will improve patient satisfaction and GP education. In addition, parental confidence in GPs will increase as they become more confident in managing the child's condition. This will result in fewer avoidable referrals to secondary paediatrics.