Do emergency rooms have cameras? Should they?

[atethesun]

Do EDs have cameras in every room?

It just occurs to me today after dealing with a difficult patient.
She was this 40 something woman who came in with a strange pain requesting dilaudid tablets.
Of course, I was meticulous at first trying to figuring out the etiology of her pain because she doesn't have a record at our hospital. She was thankful too because I even did a complete neuro exam on her.
Anyway, towards the end after all the tests and imaging came back negative, I told her that she's being discharged. She asked me if she can get a 30 days supply to go.
I was like, "it's not appropriate"
She suddenly turned on me saying, "you are the worst med student, I will sue you for everything blah blah blah"

The attending told me not to worry but I am just wondering if EDs have cameras to protect the employees from problems like this. (in case she starts some ridiculous lawsuits)

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[deleted109597]

I'm fairly sure that eventually there will be cameras. However, they won't be necessarily to protect us, but to "prove" that we did the exams we document.

 

[Arcan57]

Do EDs have cameras in every room?

It just occurs to me today after dealing with a difficult patient.
She was this 40 something woman who came in with a strange pain requesting dilaudid tablets.
Of course, I was meticulous at first trying to figuring out the etiology of her pain because she doesn't have a record at our hospital. She was thankful too because I even did a complete neuro exam on her.
Anyway, towards the end after all the tests and imaging came back negative, I told her that she's being discharged. She asked me if she can get a 30 days supply to go.
I was like, "it's not appropriate"
She suddenly turned on me saying, "you are the worst med student, I will sue you for everything blah blah blah"

The attending told me not to worry but I am just wondering if EDs have cameras to protect the employees from problems like this. (in case she starts some ridiculous lawsuits)

There would be huge HIPAA implications for video taping, especially considering the sensitive natue of some of our physical exam components. That being said I have two pieces of advice for you.

1) Drug seekers aren't doing their job if they don't make you feel bad/scared about not giving them narcs. These are people that in another era or socioeconomic class would be breaking into houses/mugging people/turning tricks to be able to score. A little emotional terrorism is to be expected.

2) If you get the feeling that things are going sideways or that someone who seemed legit is actually crazy-cakes, have another hospital employee in the room when talking to them. It can act as a check on inappropriate behavior (both theirs and yours) and also help mitigate patient complaints (which is far more likely than a lawsuit).

 

[OccupyTheED]

I don't know that having cameras would prevent ridiculous lawsuits, make every chart court-worthy

 

[Redrox]

Every trauma bay patient encounter is filmed at our place. Once a month surgeons go over the tapes at conference, in theory, to note what could be done better, efficiency, thoroughness, etc. In practice it just turns into heckling over interns looking awkward and who's standing around most like a *******.

A cringely, entertainingly good time if you're not the one singled out.

 

[GeneralVeers]

There would be huge HIPAA implications for video taping, especially considering the sensitive natue of some of our physical exam components. That being said I have two pieces of advice for you.

1) Drug seekers aren't doing their job if they don't make you feel bad/scared about not giving them narcs. These are people that in another era or socioeconomic class would be breaking into houses/mugging people/turning tricks to be able to score. A little emotional terrorism is to be expected.

Also known as "sociopaths". I don't ever feel bad, and I don't feel terrorized. I approach it clinically, and lay out the facts. Never get drawn into a circular argument with them. If I anticipate a difficult/confrontational discussion I bring the charge nurse or another nurse into the room to document what was said. Once I've laid out the facts, I end the discussion politely and leave.

 

[atethesun]

There would be huge HIPAA implications for video taping, especially considering the sensitive natue of some of our physical exam components. That being said I have two pieces of advice for you.

1) Drug seekers aren't doing their job if they don't make you feel bad/scared about not giving them narcs. These are people that in another era or socioeconomic class would be breaking into houses/mugging people/turning tricks to be able to score. A little emotional terrorism is to be expected.

2) If you get the feeling that things are going sideways or that someone who seemed legit is actually crazy-cakes, have another hospital employee in the room when talking to them. It can act as a check on inappropriate behavior (both theirs and yours) and also help mitigate patient complaints (which is far more likely than a lawsuit).

Why would that have any HIPAA implications if the videos are securely and digitally stored?
Just wondering, that's all. Part of me believes that it would deter malingers from making false accusations. You know what I'm saying?
Just a couple months back, one of my senior staffs was charged with sexual assault from a 30y/o woman (let's just say he doesn't even swing that way because he's quite open about it, so everyone knows he didn't do it). Nonetheless, it was just a mess for him and the hospital.

 

[atethesun]

Every trauma bay patient encounter is filmed at our place. Once a month surgeons go over the tapes at conference, in theory, to note what could be done better, efficiency, thoroughness, etc. In practice it just turns into heckling over interns looking awkward and who's standing around most like a *******.

A cringely, entertainingly good time if you're not the one singled out.

That would be most embarrassing if you are caught adjusting your underwear or something

 

[Birdstrike]

.

 

[PMPMD]

Every trauma bay patient encounter is filmed at our place. Once a month surgeons go over the tapes at conference, in theory, to note what could be done better, efficiency, thoroughness, etc. In practice it just turns into heckling over interns looking awkward and who's standing around most like a *******.

A cringely, entertainingly good time if you're not the one singled out.

That sounds hilarious (unless you're the tern in question). I got made fun of a fair deal on trauma as it was my first ms3 rotation.

Cameras in non-patient care areas would make sense in higher crime areas. Cameras in all patient care areas would invite the ACLU and Gloria Allred types to come down on you.

 

[emd123]

Every trauma bay patient encounter is filmed at our place. Once a month surgeons go over the tapes at conference, in theory, to note what could be done better, efficiency, thoroughness, etc. In practice it just turns into heckling over interns looking awkward and who's standing around most like a *******.

A cringely, entertainingly good time if you're not the one singled out.

What's the funniest thing you've seen on there? Nose picking? Wedgie removals on the sly? Sniffing own armpit to check for B.O.?

Cough up the goods, redrox.

 

[docB]

I'm fairly sure that eventually there will be cameras. However, they won't be necessarily to protect us, but to "prove" that we did the exams we document.

I agree. I've thought for years now that in the future we will have audio/video "charting." We will do stuff and then billers will watch the videos and extract the billing info.

There would be huge HIPAA implications for video taping, especially considering the sensitive natue of some of our physical exam components. That being said I have two pieces of advice for you.

There would be many issues, but none of them would be insurmountable. As for HIPAA I see that as being an IT/security issue rather than one that means it couldn't be done.

I don't know that having cameras would prevent ridiculous lawsuits, make every chart court-worthy

You are correct. It would work both ways. On the one hand the frivolous stuff would go away. But, the real screw ups would be very hard to get out of. There would also be an issue about stuff no appearing on video as it was in real life, an issue that courts currently deal with all the time in other areas.

Yes!

They will be used by the Big Brother government health care system many of you asked for, to prove you didn't ask all 10 systems on your review of systems to downgrade all of your level 5 charges to level 3's, cut your pay, and charge you with Medicare fraud.

True, you would be down coded if you didn't do the work. But you would have more time because you would not have to document. When you walk out of the room your charting is done because it's all on the tape (I'm dating myself by saying "tape"... disk?).

I envision a system where everyone has RFID chips in their ID badges and on the patient ID bracelet. Whenever two a nurse, doc, tech, whoever enters a room or comes into proximity to a patient the system starts to record. Clearly there are a lot of problems with this but it creates a lot of solutions as well.

 

[Druggernaut]

There would be huge HIPAA implications for video taping, especially considering the sensitive natue of some of our physical exam components.

The department I worked in prior to medical school installed them when they built an addition. They were only in the psych rooms, and we had monitors at the nursing stations with the intent of turning them on when placing a potentially suicidal or dangerous patient in there so that you could avoid having a sitter immediately outside the room. The HUCs and anyone else at the nursing station were supposed to keep an eye on them. They were supposed to be turned off in all other situations, but people would inevitably forget to do so.

Security had recordings of them. No one I talked to was sure if they stopped recording when the monitors were turned off.

That would be most embarrassing if you are caught adjusting your underwear or something

I definately had my share of "oh damn it, I just did that on camera" moments, and prayed nobody was watching.

 

[Redrox]

What's the funniest thing you've seen on there? Nose picking? Wedgie removals on the sly? Sniffing own armpit to check for B.O.?

Cough up the goods, redrox.

Oh, I swear they pick just the worst cases to review. Seen it all. Med student looking ill/scared/grossed out, not wearing gloves, wedgie removal, butt scratching, nose work, etc. Rather get caught doing that than be the intern who does nothing and needs to be forcibly moved out of the way 3+ times by folk actually doing something useful and needing to get to patient.

If I had to have a favorite, though, it'd be the hot xray tech coming in and everyone stopping what they're doing to all turn and look.

 

[8654Marine]

What is it about X-ray techs and hawtness?

I've seen that correlation, as well.