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By Jonathan Springston, Associate Managing Editor, AHC Media
On Oct. 8, 2014, Thomas Eric Duncan, a Liberian who became the first patient in the United States diagnosed with Ebola disease, died at Texas Health Presbyterian Hospital in Dallas, 13 days after first presenting to the ED. Less than a week later, two nurses, one of whom had treated Duncan, were diagnosed with Ebola.
Now, one year later, an expert panel convened by Texas Health Resources, the parent company of Texas Health Presbyterian Hospital, has unveiled a detailed review of how the Duncan case was managed, what went wrong, and what steps need to be taken to strengthen the hospital’s and the community’s response to future infectious disease threats.
The November issue of ED Management features a cover story that breaks down what happened in Dallas and the panel’s report, which lays blame on poor planning and communication, misunderstood roles, and inadequate drills. Below is an excerpt from the comprehensive and informative story.
The panel examined the circumstances surrounding Duncan’s first visit to the ED on Sept. 25, 2014, after which he was discharged with a diagnosis of sinusitis. The panel found that while a nurse noted in Duncan’s electronic medical record (EMR) that the patient was from Africa — a key point for consideration of EVD — this information was not highlighted or prioritized within the EMR, and it would have required the physician to look beyond the standard patient assessment screen to see the patient’s travel history. This problem, and a general lack of awareness of the risk factors for EVD, led ED staff to miss an opportunity to correctly diagnose Duncan, isolate him, and begin treatment at an earlier stage of the disease, according to the panel’s report.
The panel recommended the hospital develop and implement a plan for improving collaborative interaction between ED nurses and physicians, and it also pointed out the danger of overrelying on the EMR for communication. Jon Mark Hirshon, MD, MPH, PhD, a professor in the Department of Emergency Medicine and in the Department of Epidemiology and Public Health at the University of Maryland School of Medicine in Baltimore, agrees that overreliance on EMRs can be a problem throughout the healthcare system, and that more attention needs to be paid to making sure that these records are designed and leveraged to promote patient safety.
“It is a federal mandate for us to go to EMRs, and there are reasons and rationales behind this, but there is a challenge to it as well,” notes Hirshon, who also serves on a group focused on Ebola preparedness for the American College of Emergency Physicians (ACEP). “What has changed in the last year is that people are much more aware of asking those [appropriate screening] questions, and the communication has improved. At the same time, it is a challenge to make sure there is good communication between the providers and that the EMR is reinforcing that communication and not fragmenting it.”
Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, the immediate past president of the Emergency Nurses Association, clinical director for Emergency Services at Cincinnati Children’s Hospital in Ohio and a member of the ACEP Ebola Expert Panel, agrees with Hirshon, noting that it is very important for EMRs to be truly multidisciplinary.
“I am sure every organization has an opportunity to really look at that,” she says. “The other piece to remember is that nothing replaces face-to-face communication, and if anyone has a concern at any point in time or recognizes something that doesn’t seem right, it needs to be escalated, and a computer probably isn’t the best way to do that.”
You can read the entire ED Management story here. Also, be sure to check out the November issue of Critical Care Alert, which will also look back at last year’s Ebola crisis and what EDs across the country can learn to better handle future crises. You'll also want to sign up for AHC Media's November 10 webinar that will focus on CMS infection prevention and control standards as well as memos issued by CDC, TJC, and CMS on the topic.