HIPPA Violation Question: Triage

Specialties Emergency

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Specializes in ER, Medicine.

I was told the other day that it is a violation for the triage nurse to tell patients waiting in the lobby what the wait time is or how many people are ahead of them.

To give a brief overview of the triage process makes people feel like their problem is not serious and they get angry.

To tell them I don't know how long the wait is but we will get you back as soon as possible despite them having already waited for four hours makes them angry.

To tell them that there are 32 other people in the lobby and that they have been waiting for up to 4 1/2 hours makes them angry.

To tell them that there are three other people in the lobby and that they will have to wait for the next bed makes them angry still.

To tell them that the emergency room is not a doctors office and that we do not see people according to time again makes the patients upset.

To tell a legitimely Ill person I have no beds available and they will have to wait adds to the frustration.

Sometimes patients will tell me they have to be to work in 3 hours and cannot wait and that I need to do something now. Even if I could most of our ER visits average 4+ hours.

How do you answer this simple question appropriately and with compassion?

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Specializes in Clinical Research, Outpt Women's Health.

No identifying info = no violation.

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Not a HIPPA violation, but possibly a JCAHO issue.

We just went through this in our ER. Basically we were told that giving a wait time influences peoples decision to stay or not. Anything you do or say that can be viewed as something to encourage them to leave is a no-no, and a long wait time is something that may make them decide to leave.

It is loose-loose situation.

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I was told the other day that it is a violation for the triage nurse to tell patients waiting in the lobby what the wait time is or how many people are ahead of them.

To give a brief overview of the triage process makes people feel like their problem is not serious and they get angry.

To tell them I don't know how long the wait is but we will get you back as soon as possible despite them having already waited for four hours makes them angry.

To tell them that there are 32 other people in the lobby and that they have been waiting for up to 4 1/2 hours makes them angry.

To tell them that there are three other people in the lobby and that they will have to wait for the next bed makes them angry still.

To tell them that the emergency room is not a doctors office and that we do not see people according to time again makes the patients upset.

To tell a legitimely Ill person I have no beds available and they will have to wait adds to the frustration.

Sometimes patients will tell me they have to be to work in 3 hours and cannot wait and that I need to do something now. Even if I could most of our ER visits average 4+ hours.

How do you answer this simple question appropriately and with compassion?

Do you mean EMTALA? It sounds more like whoever told you that saying the above things are illegal is talking about violating EMTALA rules of coercion, i.e. somehow alluding to a patient in any way shape or form that they should not pursue care in an Emergency Department. This prevents hospitals from turning away patients for reasons like inability to pay, lack of health insurance, legal status, etc. However, this can include posting wait times, stating that an ED will refuse to perform certain services (like preg/std tests or med refills), and some of the things you included above because it is considered coercion.

From my experience, "coercion" is broad and loosely defined, and many healthcare professionals/institutions fear legal consequences for violationing this, and for that reason EDs have become hypersensitive to providing the smallest amount of general information to patients about wait times, care in the ED, triage process, etc. for fear of legal ramifications by patients (which is understandable; people threaten legal action/violence because they have to wait three hours for pregnancy results in an EMERGENCY DEPT).

But to prevent my futher ranting and hopefully answer your question, I explaining triage process to patients and that patients are seen in order of severity of illness is not illegal. In fact, my ED has this posted EVERYWHERE. On the contrary, we were forced to take down the "wait time" clock in our dept, but I've seen on websites of other local hospitals the ED wait times on the home page.

Damned if you do, damned if you don't? EMTALA is a great safety net, but damn, sometimes it makes patient advocacy/compassion about as fun as sticking my hand in a hot toaster. I hope this helps, and I would LOVE to hear the insight of fellow nurses!

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Not a HIPPA violation, but possibly a JCAHO issue.

We just went through this in our ER. Basically we were told that giving a wait time influences peoples decision to stay or not. Anything you do or say that can be viewed as something to encourage them to leave is a no-no, and a long wait time is something that may make them decide to leave.

It is loose-loose situation.

Yeah, and it counteracts transparency in healthcare. Patients want and deserve the honesty of healthcare professionals/institutions, but refuse to accept the concept of a medical emergency or acknowledge that the same room they are complaining about because it doesn't have a tv just had someone's mother die in it an hour before.

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Specializes in Pedi.

HIPAA = Health Insurance Portability and Accountability Act. HIPPA = ? Female Hippopotamus.

Presumably the patient, unless blind, can see how many other people there are in the waiting room. Unless you say 'Mrs Smith sitting right there has gonorrhea so she's more important than you", there's no HIPAA violation.

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Specializes in ER.

whoever said that is stupid. sorry, but yeah.

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I was told the other day that it is a violation for the triage nurse to tell patients waiting in the lobby what the wait time is or how many people are ahead of them.?

I think whoever told you that need to find another job.

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Not a HIPPA violation, but possibly a JCAHO issue.

We just went through this in our ER. Basically we were told that giving a wait time influences peoples decision to stay or not. Anything you do or say that can be viewed as something to encourage them to leave is a no-no, and a long wait time is something that may make them decide to leave.

It is loose-loose situation.

I disagree. They post the wait times online and even on electronic billboards around here.

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I disagree. They post the wait times online and even on electronic billboards around here.

Before they come to the ER, that is fine, but once they sign in, the rules change. I asked about that same thing since there are some around here that do that also.

Basically the signs and online times can help them to decide which ER to go to, but once signed in, giving times could influence them to leave.

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Specializes in HH, Peds, Rehab, Clinical.

Why in the heck would that be a HIPAA violation? Unless you're saying "that man over there with the bloody bandage on his arm is next. Mr. Johnson's injury is more pressing than your splinter"

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Specializes in HH, Peds, Rehab, Clinical.

Try "lose-lose"...

Not a HIPPA violation, but possibly a JCAHO issue.

We just went through this in our ER. Basically we were told that giving a wait time influences peoples decision to stay or not. Anything you do or say that can be viewed as something to encourage them to leave is a no-no, and a long wait time is something that may make them decide to leave.

It is loose-loose situation.

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