To the Editor: Here is a real-life example
that illustrates some of the ethical concerns raised when QI projects and
research overlap, as described by Dr Casarett and colleagues.1
We encountered barriers from our IRB while trying to study how well our emergency
department detects and follows up possible elder abuse. Concerns raised included
how informed consent could be obtained and how the study should be performed
to avoid increasing the occurrence of abuse. In addition, questions were posed
as to how the information would be handled, what the threshold would be for
reporting, and how this might adversely affect the patients. While we were
struggling with these issues, it came to our attention that the state department
of public health was conducting a QI project on the detection of domestic
violence by surveying all women who presented to our emergency department.
Because this was a QI project, there was no informed consent process. In addition,
while women who responded positively were offered assistance, there was evidently
no process of information sharing with the medical professionals.
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