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During the anthrax attacks, the need to improve internal communication became crystal clear at EDs in communities with confirmed cases of exposure. With the influx of patients with suspected anthrax exposure and rising panic, it became of the utmost importance to "close the loop" on the ED visit, says Deborah Cioffi, RN, BSN, director of emergency services at Capital Health System in Trenton, NJ, which includes the Helene Fuld Medical Center and Mercer Medical Center — Trenton.
"We had to make sure that every patient who had lab work done got a return phone call, letting them know that everything was OK," she says. The vast majority of tests were negative, and hearing from an ED physician or nurse was key to calming panicked patients, she emphasizes. To facilitate that communication, some documentation issues had to be addressed.
"Everybody was keeping their own data, including the ED, registration, employee health, and infectious disease," reports David Schreck, MD, FACEP, chairman of the department of emergency medicine. "I felt there was a need for a central data collection instrument which everyone could have access to." There were a lot of people collecting the same information, but none of it was easily accessible, he explains. "There wasn’t any one place where you could go for information about a patient," Schreck explains. "I could always walk upstairs or call someone, but there wasn’t anyplace where I could just go and access it myself. You always had to go to somebody else."
The anthrax attacks revealed the importance of all types of communication during a disaster, says Schreck. "In addition to the need for effective communication with EMS or police at the site where the problem was, there was also a need for us to communicate internally," he explains. Schreck created an electronic medical record specifically for bioterrorism incidents. The tool features all components in the patient’s medical chart, including clinical, demographic, epidemiological, and outcomes measures. "This way, you are able to keep a central log of all the vital information about the patient, with universal access for everyone involved," he says.
The tool is stored on a database, which can be accessed by various departments at different points in time, says Schreck, adding that the ED never had a chance to actually use it. "There was a period of about four weeks when these patients just kept coming in, and we were extremely busy during that time," he explains. "I designed it in the last few days of the incident. But it is ready now, should this ever occur in the future."