Objective: To determine the frequency of visual and auditory confidentiality and privacy breaches in a university ED. Methods: A prospective, observational study of medical personnel behavior was performed using participant and direct observation techniques. Observations were made in a university tertiary referral and trauma center emergency facility. Observers recorded auditory and visual confidentiality and privacy breaches in various patient care areas during I-hour periods. Information collected included patient name or room number, complainVdiagnosis, diagnostic tests, past medical history, and personal information. It was then determined whether a clear identification of the patient's name or face and/or an association to his or her clinical course could be made.Results: All members of the health care team committed confidentiality and privacy breaches. Frequency of breaches was dependent on room location and design. Breaches in the triage/waiting area occurred for >53% of the patients. Breaches near the physicianhursing station ranged from 3 to 24 per hour and 1.5 to 3.4 per patient hour. Other inappropriate comments also were noted. One hundred consecutive patients and family members were interviewed at ED release, with only 3100 having noticed the status board, although neither could recall any specific details. Conclusion: Confidentiality and privacy breaches occur in a university ED by all members of the health care team. The ED architecture and floor plan affect patient confidentiality and privacy. Key words: confidentiality; ethics; emergency department; privacy. Acad IThe right of privacy of an individual in relation to all other people includes 3 aspects: 1) privacy as a physical sphere within which others may not intrude, 2 ) privacy as freedom of choice for important decisions, and 3) privacy as control over personal information.' The principle of confidentiality is that a health care professional may not reveal to others the information provided by a patient without the patient's consent.' As is true for other specialties, emergency medicine (EM) has stated the importance of confidentiality to its practitioners. The American College of Emergency Physicians (ACEP) policy statement on patient confidentiality notes " _ . . all physicians have an important ethical and Prior publications on the issue of confidentiality in EM generally address confidentiality breaches as they relate to various clinical situations, e.g., employee health, communicable diseases, and drug te~ting.'.~.' Few articles have examined inappropriate comments made by hospital employees while in a public space (the hospital elevator)' or addressed confidentiality in the ED.' Confidentiality, particularly in policy form, also relates to the protection of specific verbal or written information. Our study sought evidence for confidentiality and privacy breaches in the ED. We also discuss how ED architecture and floor plan can affect these issues. I METHODSStudy Design: We performed a prospective, observational study of ED personnel...

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