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Table 1 The study intervention

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

Intervention

Description

Environmental space reorganization and process management

We reorganized space and assigned space utility according to different treatment purposes. An observation area was set aside for those patients expecting to stay in the ED for a longer period of time (usually more than 6 hours) for observation or later admittance to the ward. The observation area was set up in the inner area of the ED with a quieter and more private environment equipped with healthcare providers caring for these patients. Patients would be moved from the treatment area to the observation area when necessary. However, patients would be moved back to the treatment area if medical conditions warranted it.

Access control

Limited access to the treatment area would protect patient privacy and safety as well as allow healthcare providers to function without interference. To avoid the ED being open to the public and used as an access way, a card reader system was introduced to allow the ED staff, delivery personnel, and other authorized persons to access the ED. An entry sign was placed to explain why the access control was essential for assisting in the protection of patient privacy and safety.

Bioethics education and training

Institutional level

Many educational activities for continuing further staff education and training after the implementation of the intervention were introduced. A one-day workshop per month was provided during August to October in 2008 for all hospital healthcare providers and dealt with clinical ethical issues in terms of ethics consultation, privacy and confidentiality, disclosure of medical information, and professionalism, etc. Our management concept, emphasizing adherence to medical ethics and accountability for social responsibility, were reaffirmed and all hospital healthcare providers were educated about this. Moreover, special speech training for patient privacy is held annually for all healthcare providers, as well as educational training for all new medical students, residents, and staff.

ED level

In collaboration with the education of all hospital healthcare providers, we coordinated case conference meetings at the ED monthly, shaping policies and implementing strategies for improving ED patient care in terms of privacy, confidentiality and satisfaction. The ED staff was trained to be sensitive to patient privacy and ensure confidentiality. For example, performing procedures and physical examinations in the public areas should be avoided if at all possible. Healthcare providers were reminded to use the treatment rooms or movable screens to protect patient privacy, to be aware of the surrounding environment concerning patient information being overheard by others, to keep their voices down when discussing patient information, and to avoid leaving notes with patient information and charts in the public areas that could be easily accessed by irrelevant persons, etc.

Feedback from healthcare providers was collected after each educational activity, and most staff responded with satisfaction and acknowledged that the education and training would be helpful for their practice and patient care.

Encouraging ethics consultation

The staff have encouraged ethics consultation to allow patients to express their ethical concerns. Some seed staff members were selected and specially educated to provide peer support for other staff regarding ethical concerns in their own departments.