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Barlas D, Sama AE, Ward MF, et al. Comparison of the auditory and visual privacy of emergency department treatment areas with curtains vs. those with solid walls. Ann Emerg Med 2001; 38:135-139.
If a patient is in a treatment area with curtains, he or she feels there is significantly less visual and auditory privacy than if he or she is in a room with solid walls, says this study from North Shore University Hospital in Manhasset, NY.
A total of 108 adult patients were surveyed. Patients received care in one of three locations: a room with solid walls and a door, a curtained area next to the nurse’s station, or a curtained area away from the nurse’s station.
Patients in the curtained areas tended to believe that they could overhear others and that others could overhear personal information and see personal parts of their bodies. Patients in the curtained areas reported an overall lower sense of privacy.
Of all patients, 92.6% felt that they had experienced as much privacy as they expected, with no difference between areas.
If privacy is compromised, ED patients may be reluctant to share personal information or be examined, the researchers assert. They add that patients also may be less satisfied with the care they receive.
Although the Joint Commission on Accreditation of Healthcare Organizations permits use of curtains in the ED if they provide adequate visual and auditory privacy, patient privacy and confidentiality in EDs with curtain partitions may be inadequate in many cases, argue the researchers.
Although almost all patients reported that they received as much privacy as expected, four patients surveyed withheld portions of their history or refused part of their physical examination because of lack of privacy.
"Four of 108 individuals surveyed may appear to be few, but in an ED with an annual census close to 40,000, several individuals may be withholding potentially important information or refusing portions of their examination daily," they conclude.
The authors recommend the following:
• When renovating your ED, consider patient privacy along with the conflicting need for direct patient observation and efficient patient flow.
• If curtain partitions are used, ensure that they are always completely drawn around treatment areas, particularly when patients are undressed.
• Keep in mind the limited auditory barrier provided by curtains.
• Replace lightweight curtains with thicker, more sound-absorbent material.
• Increase the space between treatment bays.
Weigand JV, Gerson LW. Preventive care in the ED: Should emergency departments institute a falls prevention program for elder patients? A systematic review. Acad Emerg Med 2001; 8:823-826.
A falls prevention program for patients age 65 and older could result in significant reduction of risk, according to this study from Northeastern Ohio Universities College of Medicine in Rootstown and Summa Health System in Akron, OH.
The researchers reviewed 26 articles in the emergency medicine literature to assess the effectiveness of an ED intervention for patients 65 and older who are at high risk for falls. Here were key findings:
• One study showed that an intervention decreased subsequent falls in elderly patients who presented with a fall.
• Two studies showed it was possible to identify ED patients at risk for falls.
• Falls in elders result in significant morbidity and mortality.
• With a structured intervention in ED patients who have fallen, there were decreases in the number of falls, the risk of recurrent falls, and the number of hospitalizations.
The researchers recommend that EDs consider clinical interventions to identify, counsel, and refer ED patients 65 or older who are at high risk for an unintentional fall.
Counseling to reduce the risk of falling may include exercise, training to improve balance, safety-related skills and environmental hazard reduction, and monitoring and adjusting medications as needed, they suggest. (See patient handout on Home Safety, in this issue.)