Self-documentary in the emergency department: Perspectives on patients recording their own procedures

Oyedokun, Taofiq; Donauer, Andrew; Stempien, James; McKay, Shari

doi:10.1017/cem.2018.423

Cited by 7 publications

(36 citation statements)

References 8 publications

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“…Clinicians are increasingly working under a critical public lens and the healthcare sector is exposed, resulting in an imperative to develop policies and practices that meet patient needs, while protecting the interests of clinicians and the health service 2–10. Previous studies have shown that up to 93% (n=37–360) of doctors2 4 11 and 47% of nurses (n=92–119) had experienced a patient-led recording 2 4. There is a substantial body of research that investigates the provision of audio recordings of clinical discussions to patients 12–14.…”

Section: Introductionmentioning

confidence: 99%

“…Previous research has called for hospital policies to guide clinician practice when a patient asks to record 2 3 6. In the hospitals where this study was undertaken, the distinct policies for medical and birthing contexts place the onus on clinicians to consent to a recording or not, based on appropriateness, use of the recording for private purposes and with the consent of all relevant parties.…”

Section: Introductionmentioning

confidence: 99%

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Smartphone standoff: a qualitative study exploring clinician responses when a patient uses a smartphone to record a hospital clinical encounter

et al. 2022

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ObjectivesPatients are initiating recordings of their clinical encounters using a smartphone. While this is an important, universal issue, little is known about the clinician viewpoint. Understanding clinician perspectives and behaviours is key to ensuring the protection of patient and clinician interests. This study aimed to gain a deep understanding of clinician attitudes and behaviours to patient-led recordings of hospital clinical encounters.DesignSemistructured interviews were conducted with 20 hospital clinicians. Participants were recruited using a combination of purposive and snowball sampling. Interviews were digitally recorded and transcribed. Transcripts were analysed using thematic analysis.SettingThis study took place at two hospitals in the metropolitan area of Gold Coast, Australia.ParticipantsParticipants included clinicians with varying levels of experience, or clinical managers in the roles of: medical, nursing and midwifery, and allied health staff.ResultsThe 20 participants interviewed were from a range of health disciplines and clinical areas and most had experienced a patient-led recording. Three themes emerged when exploring participant attitudes. First, that recording was a significant and controversial topic. Second, that experiences often informed clinician attitudes and many clinicians held conflicting views. Finally, a perceived loss of control was a significant stressor. A further three themes emerged relating to clinician behaviours when a patient asks to record. Decision-making involved balancing multiple factors often in pressurised situations. Shared decision-making was shaped by power dynamics and, finally, decision-making was not informed by hospital policy.ConclusionsWhile patient-led recordings were viewed as beneficial, clinician welfare and patient safety may be at risk when a patient records a clinical encounter. Current safeguards, such as hospital policies, are not used and may not meet the needs of clinicians when decision-making is complicated by power dynamics. More research is needed to better understand how clinicians can be supported in this critical domain.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Smartphone standoff: a qualitative study exploring clinician responses when a patient uses a smartphone to record a hospital clinical encounter

et al. 2022

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“…Although we do not know the contexts under which these incidents occurred, 2 of the nurses in our study spontaneously recalled, respectively, that a patient overheard a conversation that they should not have been privy to and also that another nurse sensed they had been filmed by a member of the public. Both of these nurses felt uncomfortable about what had occurred, and with the findings by Oyedokun et al [42], these incidents continue to raise the question of what degree of informational and physical privacy should be afforded to health care providers. Future research is warranted.…”

Section: Discussionmentioning

confidence: 91%

“…In terms of patients’ perceptions of, and experiences with, making a cell phone recording in a hospital setting, Oyedokun et al surveyed 110 patients who were treated for a laceration potentially requiring suturing at one of the 3 EDs located in the Canadian province of Saskatchewan [42]. To contrast patient perspectives about recording with the opinions of health care providers, 156 ED professionals (19 nurses and 37 physicians) who practiced at one of the 3 sites were also recruited into this study.…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Study of the Theory Behind the Chairs: Balancing Lean-Accelerated Patient Flow With the Need for Privacy and Confidentiality in an Emergency Medicine Setting

et al. 2019

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Background Many emergency departments (EDs) have used the Lean methodology to guide the restructuring of their practice environments and patient care processes. Despite research cautioning that the layout and design of treatment areas can increase patients’ vulnerability to privacy breaches, evaluations of Lean interventions have ignored the potential impact of these on patients’ informational and physical privacy. If professional regulatory organizations are going to require that nurses and physicians interact with their patients privately and confidentially, we need to examine the degrees to which their practice environment supports them to do so. Objective This study explored how a Lean intervention impacted the ability of emergency medicine physicians and nurses to optimize conditions of privacy and confidentiality for patients under their care. Methods From July to December 2017, semistructured interviews were iteratively conducted with health care professionals practicing emergency medicine at a single teaching hospital in Ontario, Canada. The hospital has 1000 beds, and approximately 128,000 patients visit its 2 EDs annually. In response to poor wait times, in 2013, the hospital’s 2 EDs underwent a Lean redesign. As the interviews proceeded, information from their transcripts was first coded into topics and then organized into themes. Data collection continued to theoretical sufficiency. Results Overall, 15 nurses and 5 physicians were interviewed. A major component of the Lean intervention was the construction of a three-zone front cell at both sites. Each zone was outfitted with a set of chairs in an open concept configuration. Although, in theory, professionals perceived value in having the chairs, in practice, these served multiple, and often, competing uses by patients, family members, and visitors. In an attempt to work around limitations they encountered and keep patients flowing, professionals often needed to move a patient out from a front chair and actively search for another location that better protected individuals’ informational and physical privacy. Conclusions To our knowledge, this is the first qualitative study of the impact of a Lean intervention on patient privacy and confidentiality. The physical configuration of the front cell often intensified the clinical work of professionals because they needed to actively search for spaces better affording privacy and confidentiality for patient encounters. These searches likely increased clinical time and added to these patients’ length of stay. We advocate that the physical structure and configuration of the front cell should be re-examined under the lens of Lean’s principle of value-added activities. Future exploration of the perspectives of patients, family members, and visitors regarding the relative importance of privacy and confidentiality during emergency care is warranted.

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“…This simulation model helped in evaluating the effect of probable variations to the system by considering different circumstances. Joubert et al (2015), De Freitas et al (2018) and Oyedokun et al (2019) introduced lean manufacturing concept in health care and discussed the effect of employing a physician in triage to improve the ED efficiency. They showed that triage physicians influence "low-severity" patients LOS significantly but they do not affect acute patients.…”

Section: Emergency Department Efficiencymentioning

confidence: 99%

Emergency department resource optimisation for improved performance: a review

et al. 2019

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Emergency departments (EDs) have been becoming increasingly congested due to the combined impacts of growing demand, access block and increased clinical capability of the EDs. This congestion has known to have adverse impacts on the performance of the healthcare services. Attempts to overcome with this challenge have focussed largely on the demand management and the application of system wide process targets such as the "four-hour rule" intended to deal with access blocks. In addition, EDs have introduced various strategies such as "fast tracking", "enhanced triage" and new models of care such as introducing nurse practitioners aimed at improving throughput. However, most of these practices require additional resources. Some researchers attempted to optimise the resources using various optimisation models to ensure best utilisation of resources to improve patient flow. However, not all modelling approaches are suitable for all situations and there is no critical review of optimisation models used in hospital EDs. The aim of this article is to review various analytical models utilised to optimise ED resources for improved patient flow and highlight benefits and limitations of these models. A range of modelling techniques including agent-based modelling and simulation, discrete-event simulation, queuing models, simulation optimisation and mathematical modelling have been reviewed. The analysis revealed that every modelling approach and optimisation technique has some advantages and disadvantages and their application is also guided by the objectives. The complexity, interrelationships and variability of ED-related variables make the application of standard modelling techniques difficult. However, these models can be used to identify sources of flow obstruction and to identify areas where investments in additional resources are likely to have most benefit.

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Self-documentary in the emergency department: Perspectives on patients recording their own procedures

Cited by 7 publications

References 8 publications

Smartphone standoff: a qualitative study exploring clinician responses when a patient uses a smartphone to record a hospital clinical encounter

Smartphone standoff: a qualitative study exploring clinician responses when a patient uses a smartphone to record a hospital clinical encounter

A Qualitative Study of the Theory Behind the Chairs: Balancing Lean-Accelerated Patient Flow With the Need for Privacy and Confidentiality in an Emergency Medicine Setting

Emergency department resource optimisation for improved performance: a review

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