--- jean francois Pion <[EMAIL PROTECTED]> wrote: > Charles Brault a écrit : > > Pas chère > > Enregistreuse numériques (horodatés) > > Mise en marche lors de l'appel > > Change la mémoire poste appel > > > > À faire approuver par son comité déontologique > > > > Destruction des donnés vocales dans une période courte > > et prédéterminé (aucun accès aux juges et/ou avocats) > > ben en france s'il y a un pb et que tu as détruit les > enregistrements, ça va te couter chaud !
Des enregistrements qui n'aurais pas existé normalement en premier lieu ? ? ? L'alternative est de se priver de données crucial pour l'amélioration de la qualité ???? On est pour l'amélioration de l'efficacité du système ... mais pourvue que cela n'affecte pas les apparences d'efficacité (personnel et systémique) Si les Américains (Legal Warriors) on réussi à faire protéger leur données de QA/QC Je ne verrais pourquoi les Francos ne pourraient pas faire de même. Reconnaissont tout au moins qu'il y'a, comme partout ailleurs, une réticence naturelle, une peur anticipé non-fondée & un manque de véçu/expérimentation. L'argument légale qui a permis de protéger la collecte de ces données. C'est qu'elle est reconnus, plus efficace à sauvegarder les Pts que l'appareil juridique. L'un s'exerce AVANT le cafouillage, identifie des erreurs systémique & est préventif. L'autre s'applique APRÈS la faute, identifie des erreurs ponctuelles & est punitif. L'un est un outils directe d'assurance de la qualité et l'autres est un outil indirect d'assurance de la qualité. La cours dans plusieurs États à reconnus cet état de chose (la primeauté du QA/QC)et reconnu que les méchanisme de protection légale, en faisait, dans les faits, obstruction à l'exercice plein et entier > > > > Strictement entendu qu'aucune des informations tirées > > du médium d'enregistrement ne pourra être utilisé contre > > les intervenants. > > clause illégale au moins en france Et alors Rendez là légale Ou alors - Vous vous cachez derrière des excuses légalistiques La déresponsabilisation vous arrange bien Oh ! les méchants chronos, Oh ! les méchants avocats ! Ou - L'exécution vous préoccupe réellement plus que les résultats finales ! ? > > > > Vous risqué de vous retrouver avec une mine de données > > objectives... ce qui est pas une mauvaise dans notre > > profession dont le terrain est suffisament hostile aux > > recherches > > c'est sur que c'est pas facile, mais ça pourrait etre > intéressant d'avoir les conversations avec le réa de > garde ou le chir ou le neuro chir d'enregistrées, > seulement en france on n'a pas le droit sans prévenir les > autres, la seule solution c'est d'obtenir une ligne > enregistrée officielle aux urgences, avec accord de la > CME, pour pouvoir appeler les chir/réa/spé divers de garde Ouais Mais c'est déjà moins scientifique Et le but de la recherche n'est pas totalement désinterressé Vos lignes du 15 sont enregistrées ? Il n'y a pas de grand écart dans la réalité que vos lignes de consultations le soit aussi pour des raisons d'assurance de la qualité. Non ? Les protocole de recherches préhosp. a déjà permis des "pré-consentement" publique en émettant des avis publiques (journaux etc.) demandant au Pts potentiel de s'objecter au projet de recherche ou de s'inscrire en refus. Assez mince comme outils, mais accepté et suffisant pour passer les qqs dernières considérations éthiques. > > et comme c'est étonnant il n'y a pas beaucoup d'hopitaux > où ça a été accepté > > bizarre non ? Du tout Mais c'est peut-être un indice Qu'il y'a bien des gens qui savent qu'il y'a une mine d'or Et il font mine de pas l'avoir)))) Charles QA/QC : Quality Assurance / Quality Control Video in the Trauma Room 2 Date: 24.03.97 15:43 From: Madhu Saxena [EMAIL PROTECTED] I work in a level one trauma center.To improve the performence in a trauma code, we are planning to install a video camers in our trauma room.This will be only for educational purpose for team members ,will not be a part of medical records and will be erased after viewing.I would like to know if in your knowledge there are video camers in EDs ? Is there any legal issue like patient's confidentiality (even though it will not be a part of medical records, and will be purely for teaching purpose for residents.) and how to overcome this obstacle?I will appreciate your experience or infrmation regarding this. Date: 25.03.97 02:30 From: Maggi Gunnels [EMAIL PROTECTED] Dr. Saxena - Parkland Hospital Emergency/Trauma Services in Dallas, Texas has policies in place re/ED videotaping that may answer your questions ( I was previously a manager there). (214)590-8735. Maggi Gunnels,OHSU Trauma Program, Portland, Oregon Date: 25.03.97 02:43 From: "John A. Aucar, M.D." [EMAIL PROTECTED] Videos made as part of a structured internal review process for quality improvement are protected from discoverability for civil proceedings by the same privilege that protects written QA documents. They are not protected from subpena as evidence in criminal proceedings. There may be ethical concerns about releasing tapes which may violate physician-patient confidentiality. Suppose for instance that a patient confesses to a crime in your emergency room, should that be reported or released? Some potential strategy include random taping and early erasure. There is probably no sure way to avoid a headache, but I still think that the process is valuable. JAA -- John A. Aucar, M.D.,F.A.C.S. Dept. of Surgery One Baylor Plaza Houston, TX 77030 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Assistant Professor, Surgery, Baylor College of Medicine Ben Taub Gen. Hospital; http://www.bcm.tmc.edu/surgery/ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Date: 25.03.97 14:53 From: "Smith, J. Stanley, MD" [EMAIL PROTECTED] Police can confiscate tapes of resuscitations of suspected criminals. Does not apply to confidentiality laws, but can be gotten with search warrant. Date: 26.03.97 22:24 From: [EMAIL PROTECTED] (John B. Kortbeek) W.r.t. video cameras in the trauma room. I am currently a trauma surgeon and medical director at a tertiary referral trauma facility. Some years ago as a trauma fellow at a major state trauma center I was given the task of reviewing the videos for quality improvement. The job was not very rewarding, it was a laborious method of assessing the resuscitation process. In my view simple parameters (trauma team response times, time in the emergency bay, time to OR/ICU or CT/Angio, missed injuries, and notations of difficult airway/IV access) are easy to record and provide a more efficient means of assessing trauma team performance. The most rewarding moment in reviewing the tapes was a spontaneous demonstration during a particularly uneventful trauma resuscitation when the residents gathered in front of the camera and delivered a soliloquy, singing the praises of trauma care, affirming their unending devotion to the care of gunshot wounds and their particular affinity for the current trauma fellow. John B. Kortbeek Date: 30.03.97 01:57 From: Peter Meade MD [EMAIL PROTECTED] In my institution, videotaped trauma resusitations have been used as political weapons of physicians vs physicians, and the Emergency Medicine Department vs the Surgery Department... and they were stopped when the co-axial cable was cut by secret order of the Chief of Surgery... Much fighting and ill-will have been generated by the use of these "educational" devices. Nope... Video Cameras in the ED are not a very good idea. Peter Meade, MD SICU Director King/Drew Medical Center Los Angeles Date: 30.03.97 18:17 From: "Roy L. Alson, PhD, MD" [EMAIL PROTECTED] We have been using video tapes of trauma resuscitations for years, as a QI tool. The tapes are reviewed regularly by ED and Trauma staff and then erased. They are seen only be members of the services, involved in the care of trauma patients. This is analagous to performing chart reviews for QI and one should take the same safeguards for protection of patient confidentiality for the tapes, that one does for chart reviews. We also include in our QI protocol a discussion of how tapes are used and how they are handled. Hope this helps. Regards, Roy ++++++++++++++++++++++++++++++++++++++++++ Roy L. Alson, PhD, MD, FACEP Assistant Professor of Emergency Medicine Bowman Gray School of Medicine Medical Director-EMS NC Baptist AirCare Date: 02.04.97 22:47 From: Yasser Mohsen [EMAIL PROTECTED] It appears ED goings on are becoming more and more theatrical. ED workers require an increasing audience to be able to do what has always been done without melodrama, fanfare or applause. Not surprised that Video Cameras have generated much fighting and ill-will in your hospital. The gap between regimented protocols followed in ED and gut feelings of surgeons is difficult to bridge. When ED departments chiefs stop imagining that the rest of the hospital is at their beck and call just so as they can swell the number of spectators at trauma calls, as happens in this country, then maybe these "educational" devices will not generate ill feelings. Date: 03.04.97 15:45 From: Glen Hawkins [EMAIL PROTECTED] No I think the politics were more at fault here. The video is a useful teaching tool and QI if people are willing to swallow their own ego and accept constructive criticism....a trait which is sadly lacking in our profession these days. Cheers Glen Glen Hawkins ([EMAIL PROTECTED]) Trauma Team Performance Indicators Date: 18.03.97 13:15 From: Tim Coats [EMAIL PROTECTED] Hi, We are at present looking at how we should audit the performance of our trauma team, facilities for video recording are in place (although I am aware of the legal difficulties that may surround this). We would be very interested to hear how you audit this phase, and the quality indicators that you have used. What makes a good trauma team? How do you train Team Leaders? Also, how do you feed this information back to the clinicians in a way that leads to improvement in quality? Tim Coats Mr. T. J. Coats FRCS. Senior Lecturer in Accident and Emergency / Pre-Hospital Care. Royal London Hospital. Date: 19.03.97 13:16 From: Eric Frykberg MD I'm not sure videos help in this assessment at all--it may serve as a teaching tool for criticisms of performance, but not for assessing quality. Documenting response times and time spent in the trauma resuscitation area, as well as preventable death evaluation, are examples of quality indicators we use. Eric Frykberg, M.D. Jacksonville, Fl Date: 19.03.97 15:36 From: "Dr. Ed Walker" Tim - Our hospital is part of the Yorkshire MTOS (Major Trauma Outcome Study) group. While this does not specifically look at trauma teams, or their leaders (its more about TRISS methodology and league tables - supposedly anonymous, but you can usually guess), they may have ideas about auditing teamwork. Videoing resus. room scenes is something I am not a big fan of. Unlike some members of the profession, I don't perform well in front of a camera, and I bet even '999' give you the option of asking them to stop filming while you have a third go at that drip. Date: 19.03.97 22:29 From: "John A. Aucar, M.D." There may be something to be said for customizing the indicators and the mechanism for feedback evaluation of trauma resuscitation. Besides avoiding the distasteful notion that what I do is what you should do, developing your own program will more efficiently address your own areas of weakness. The alternative is to exert a certain amount of effort to identify what you already do right, which is a less effective way to use the system. We, until recently, reviewed tapes with our residents both individually and in a quality assurance conference. The approach I recommend is to review some resuscitations, consider what parts you are happy with and what parts seem lacking. Focus on the areas that seem deficient and follow that until it improves. Notice weather you can always readily identify who the trauma team leader is. Often the designated leader is not the one who is taking charge. How occupied is the leader in doing jobs that should be delegated? How organized is the process of delegating responsibilities. How many people are in the room who are not actively contributing. I find these issues more relevant than timing how long before someone listens to the chest (30 seconds vs 1.5 minutes, if it's 20 minutes, maybe you had better look at it). Most who use this method of self evaluation and review find it very helpful, even if a bit painful. Good luck. JAA -- John A. Aucar, M.D.,F.A.C.S. Dept. of Surgery One Baylor Plaza Houston, TX 77030 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Assistant Professor, Surgery, Baylor College of Medicine Ben Taub Gen. Hospital; http://www.bcm.tmc.edu/surgery/ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Date: 20.03.97 16:26 From: John Trickett [EMAIL PROTECTED] Tim, We have also been faced with this one, and on reveiwing the literature there was a limited amount of information on "team performance". We took a consensus on a variety of indicators relevent to the resucitation phase, and tried to apply a "reasonable" quantifier. This was then developed into a "tool" which I have appended for your review. It may be found that some of the time lines are not approriate for other settings. (Eg our penetrating rate is 5%) The tool was used over a two monthe period and we were quite pleased with its performance, as an indicator of areas doing very well, and those which needed improving. If looking at using this tool, it is vital to have "buy in" from those involved in the evaluation process. There are a few items not included on the tool which we use as quality indicators, but we have access to them through our regular data base. (Eg Emergency dept length of stay, frequency of charting, etc) The appended tool was published, along with another similar evaluation tool from Salem Oregan, in The International Journal of Trauma Nursing, Vo 2, (4) October 1996. I look forward to comments on the tool and its applicability elsewhere. Good luck John Trickett RN Trauma Coordinator Ottawa General Hospital 501 Smyth Ottawa Canada Date: 20.03.97 17:27 From: Mr M Akmal [EMAIL PROTECTED] Hi Tim, Interesting question. Having participated in the trauma team myself. I think there is no doubt that the team functions best with a clear, precise and well spoken team leader. As far as training team leaders goes, how about the traditional practices of surgery in which they are taken through some cases with an experienced trauma team leader. Initially only watching and then being allowed to do more. Trauma interspecialty meetings and regular case presentations are an excellent way to teach and learn. Auditing performance is very difficult unless you have specific parameters that you would like to look at ie cost, survival, time delays etc. I agree it is very difficult to audit quality of the trauma team itself, more so when you try to look at it as a system isolated from the rest of the hospital ecosystem. Best regards Mo Mr M Akmal BSc FRCS Royal London Hospital Date: 22.03.97 00:09 From: [EMAIL PROTECTED] (Mr D.F. McGeehan) Hi Tim Enjoyed your talk in London on Thursday. While I worked in Stoke Professor Mike Smith ran a computer program in graphic tablate form that plotted trauma resuscitation. It gave a graphic readout. The learned Professor has now moved to London but if you were interested I could give you his address and I am sure he would be happy to demonstrate it for you. He is a man years ahead of his time Danny Mr D.F. McGeehan MB FRCS FFAEM Consultant in A & E Medicine Stafford District General Hospital Stafford Date: Fri, 11 Oct 1996 20:49:19 From:[EMAIL PROTECTED] Many on these webs use VIDEO recordings in the shock room or the ICU for QA and educational purposes. The following is a must read as it has bearing on your future. A patient was brought to one of the nations busiest trauma centers following a penetrating wound. In the presence of a peace officer the patient alledgedly admitted to a crime or a series of crimes. The peace officer saw the signs about the video recordings and immediately obtained a court supena to obtain the video recording. The trauma coordinator who always distroys the videos after they are viewed in a QA conference within 5 days had already given the video to the chief of trauma who had called the lawyers for the hospital and the medical school. The doctor had been told to lock up the video and not give it to anyone until a request to deny the prosecutors request was sent to the judge. After a brief was prepared by one of the nations best law firms (at great expense) the judge denied the request and mandated the tape. The judge stated that in a criminal case there is NO physician/patient privledge NOR is there any protection from seizing ANY material from a hospital or physician INCLUDING ALL QA material. The judge went on to say that the video material is also NOT protected from even CIVIL seizure should the court want it. The decision was discussed in detail and finally, only the edited portion containing the alledged confession and conversations with the peace officer were given to the prosecutor and judge. (BUT THEY DID GET THIS PIECE). The Hospital administation did not understand the principle underlying the physicians stand and stated up front that the QA tapes should be given to the judge and prosecutor. The origional tape has not yet been distroyed at the instructions of the judge, but is still in the safe of the lawyer of the doctors. THis occurance has far reaching consequences on our QA programs and deserves discussion on all of these boards. Many many more details exist, but only the prinicples which have openly been discussed in the halls and conferences of the hospital are cited here. THe physicians do not know of nor have any opinion as to the guilt or innocence of the patient. The physicians and nurses concerns rest with the QA process and protection under the hospital, JCAHO, and the law. The hospital administration mandates that the nurses and physicians actively participate and sign the QA material so the hospital can get certified by JCAHO. THe nurses and doctors are very near refusing to participate in ANY QA activities as the hospital took the stand that if a judge really wants something, just give it to them. Date: Fri, 11 Oct 1996 21:49:56 From: Harvey Louzon [EMAIL PROTECTED] The hospital attorneys were correct to ignore the physician's hysterical response and to comply with the judges orders. Physicians should not place themselves in the position of obstructing the administration of justice. Date: Fri, 11 Oct 1996 22:55:29 From: David Crippen [EMAIL PROTECTED] It is, and has always been my opinion that video taping ANYTHING in a patient care area is fraught with INFINITELY more problems than benefit. I would NEVER allow ANY videotaping of ANYTHING in a patient care area at our facility for ANY reason. A word to the wise is usually sufficient. Date: Sat, 12 Oct 1996 01:49:10 From: Todd Kelly [EMAIL PROTECTED] I disagree completely. Although I too want to see criminals put behind bars, the information gained from these tapes for medical educational purposes is too valuable. If these tapes are going to be subpoened by the courts I fear that doctors will refuse to tape at all. Afterall, the only logical next step is that the videos can be used against the treating physician in court. Date: Sat, 12 Oct 1996 16:07:42 From: Ed Kelly [EMAIL PROTECTED] Wait a minute. Is this admissable evidence? Did the patient hear and understand his Miranda rights? Was he given an opportunity to confer with his lawyer? Was he even questioned by a police officer, or did he simply say "I shot citizen X" in response to a doctor's questioning? These are important issues because they determine whether the video is a record of the doctors' interview of the patient (confidential and not subject to subpoena) or the police officer's questioning of a suspect (admissable evidence, subject to rules and limitations concerning handling of evidence). Date: Mon, 14 Oct 1996 10:00:58 From: Dick Burrows [EMAIL PROTECTED] Video training may well be useful but it is also something whih is likely to destroy patient confidentiality. However I'm not sure WHAT training if the tapes are destroyed within a few days. There is also an argument which says that social justice is important - more important than any confidential discussion between doctor and patient - indeed the judge could probably subpoena you to give evidence and if you refused he might throw you in porridge. The same goes for your notes. The journalist often faces the same problem but more accurately the priest faes it when he hears a confession of murder. I don't know what the final answer is but I do know that in respect of the trust that is necessary between doctor and patient it is vital to maintain confidentiality. I think under these circumstances it is obviously dangerous to question the means whereby he came by his wounds. It is also likely to be quite irrelevant as surely it is enough surely to know that he has been shot or stabbed or whatever. you shouldn't need to know the why's and the wheretofors in order to treat him. Date: Sat, 26 Oct 1996 16:21:27 From: Bartholomew Tortella [EMAIL PROTECTED] I am still unclear as to why the hospital did not appeal the ruling of the first judge. Provision of the tape, albeit edited, seems improper and I would go to the appellate level at least if not above that before I obeyed the court order. Clearly there was not time constraint and an appeal of the original judge's order seem appropriate. Date: Sun, 27 Oct 1996 13:44:49 From: Ken Mattox [EMAIL PROTECTED] They did not appeal because the lawyers told them that this was a criminal not civil issue and that they would loose in the long run. Date: Wed, 30 Oct 1996 16:37:10 -0500 (EST) From: Bartholomew Tortella [EMAIL PROTECTED] I realize that the mattter was criminal, but the hospital has every right to appeal if they believe the physician-patient relationship was violated. Appeals of jurdge's orders and ruling are commonplace. I believe they got BAD ADVICE from their lawyers. Remember, an opinion from the hospital lawyers is just that, an opinion. The hospital might think about asking for a second opion or the trauma docs might think about retaining their own counsel. --- URG-L Pour quitter URG-L, envoyez un message a la liste ([email protected]) avec, COMME SUJET, le mot REMOVE (rien d'autre).
