Collateral in the ED

[Auvelity]

Hey guys:

As far as I am aware, in my state you don't require consent from the patient to call family members for collateral information (might be true for all states in emergency situations?), question is, how much information (if any) can you disclose in regards of the reason why you are calling for?

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[splik]

HIPAA has an exception for breaching confidentiality in emergencies so you can disclose information without patient consent. However, it is still good clinical practice to ask patient consent before making any disclosures and keeping any such disclosures to a minimum. Really, the breach is letting the person you are getting collateral from know that the patient is in the emergency room. Usually tell them they are safe and explain you cannot reveal too much if they want to know more than is appropriate. The main time you will need to disclose more is if you are trying to verify the pt's story then you may have to disclose what the pt told you to corroborate. In terms of how much to disclose, use common sense. Keep things to a need to know basis. The emergency exception does not give you carte blanche to disclose more than is strictly necessary.

 

[NickNaylor]

HIPAA has an exception for breaching confidentiality in emergencies so you can disclose information without patient consent. However, it is still good clinical practice to ask patient consent before making any disclosures and keeping any such disclosures to a minimum. Really, the breach is letting the person you are getting collateral from know that the patient is in the emergency room. Usually tell them they are safe and explain you cannot reveal too much if they want to know more than is appropriate. The main time you will need to disclose more is if you are trying to verify the pt's story then you may have to disclose what the pt told you to corroborate. In terms of how much to disclose, use common sense. Keep things to a need to know basis. The emergency exception does not give you carte blanche to disclose more than is strictly necessary.

In addition to this, you also need to make sure that your state doesn't have privacy statutes that may be more restrictive than HIPAA. My state has these statutes and they're more restrictive, so while contacting family for collateral if they lack the capacity to provide/refuse consent is acceptable, our state statute is far more restrictive and this isn't allowed.

 

[robellis]

In addition to this, you also need to make sure that your state doesn't have privacy statutes that may be more restrictive than HIPAA. My state has these statutes and they're more restrictive, so while contacting family for collateral if they lack the capacity to provide/refuse consent is acceptable, our state statute is far more restrictive and this isn't allowed.

It’s not allowed in emergency situation to contact collateral?

 

[NickNaylor]

It’s not allowed in emergency situation to contact collateral?

Not in our state. The circumstances in our state statutes that allow you to contact others about a patient regarding anything mental health related without explicit, written consent are extremely narrow.

 

[robellis]

Not in our state. The circumstances in our state statutes that allow you to contact others about a patient regarding anything mental health related without explicit, written consent are extremely narrow.

So how the hell do you practice emergency psychiatry? 80 percent of the job is collateral lol, do you just admit everyone?

 

[whopper]

Unfortunately you'll sometimes have to admit people that didn't need to be admitted because you won't have enough information obtainable in the ER. In general lots of the people who come into the ER you will be able to figure it out because there's enough collateral, there's just enough information even without collateral, or they're a repeat "frequent flyer" and everyone knows what's going on.

 

[comp1]

HIPAA already seems extremely dangerous. It's terrifying that states might somehow come up with something more restrictive...

 

[Sushirolls]

More terrifying to me is violating liberty, personal freedom, and one's civil rights. I see the opposite as more terrifying.

 

[comp1]

People are being inappropriately admitted to psychiatric hospitals against their will due to these restrictions. That's a heck of a lot worse personal freedom violation than collecting collateral.

 

[FlowRate]

HIPAA already seems extremely dangerous. It's terrifying that states might somehow come up with something more restrictive...

HIPAA mostly enabled information sharing between healthcare parties and has little to do with a physician's duty of confidentiality which existed prior to HIPAA.

There are of course other aspects to HIPAA around information storage and what not that are not directly related to confidentiality and disclosures per se.

 

[clausewitz2]

HIPAA mostly enabled information sharing between healthcare parties and has little to do with a physician's duty of confidentiality which existed prior to HIPAA.

There are of course other aspects to HIPAA around information storage and what not that are not directly related to confidentiality and disclosures per se.

Yeah, it's not HIPAA's fault that its name gets taken in vain anytime any healthcare system is unwilling, unable, or uninterested in sharing information.

 

[Mass Effect]

People are being inappropriately admitted to psychiatric hospitals against their will due to these restrictions. That's a heck of a lot worse personal freedom violation than collecting collateral.

100%, not to mention the lifelong professional and personal consequences that can stem from an involuntary admission.

 

[Sikrouf]

I work in France
In the ER collarerals are called with NO exeptions whenever someone in a suicide crisis and/or with AD, MDD or psychotic disorder comes in and isnt hospitalised

 

[Merovinge]

I work in France
In the ER collarerals are called with NO exeptions whenever someone in a suicide crisis and/or with AD, MDD or psychotic disorder comes in and isnt hospitalised

I appreciate you sharing, always nice to hear how other countries handle these situations. I wish there was a chart that showed this across the globe to see how country privacy/involuntary hospitalizations/etc stack up.

 

[mistafab]

I tend to disclose more when I am using collateral as additional decisionmakers for care. I.e. if a known patient suffering w/ SZ presents to ED and for example their mother is primary caretaker, you bet I disclose my thoughts on the case and have a mutual discussion with them about plan moving forward. Given how much psychosocial factors play into ED presentations, it is sometimes imperative to disclose information to give the best possible care and provide the safest outcome. I don't disclose more than necessary, but in my state it is completely legal and defensible to discuss emergency cases with anyone I need to.