Lessons healthcare workers can learn from Ebola crisis in Dallas
Friday, October 03, 2014
As many are aware, the first travel-associated case of Ebola in the United States was confirmed on Sept. 30. According to reports, the patient is currently in isolation and listed in serious condition. The CDC and other key government officials have converged on the Dallas metropolitan area as contacts are identified and educated on signs and symptoms of the disease. There are currently 100 potential contacts.
As the story unfolded, it was discovered that the patient had presented to the hospital a few days prior with nondescript complaints. At a news conference on Oct. 1, hospital officials confirmed that the patient had also told a hospital nurse of his recent travel from Liberia.
However, regrettably, the "information was not communicated to the full team," according to Dr. Mark Lester of Texas Health Presbyterian Hospital in Dallas. This contributed to the patient not being admitted and subsequently discharged back into the community.
According to all reports, a query was completed during the initial ER visit to flag and isolate patients who had recent travel outside the United States. This was in accordance with current CDC guidelines. It is currently unclear why the patient was not immediately identified and isolated in light of his recent travel.
Considering the vague signs and symptoms of an Ebola infection — fever, fatigue, nausea, vomiting, headache, abdominal pain — the question of exposure and recent travel is paramount in identifying potential patients.
It appears a few lessons can be learned from this situation and, as more information becomes known, more lessons will surface. However, in healthcare, lessons often come at a cost — human lives — but hopefully not in this case.
First, all healthcare providers need to be educated about this disease and how to respond quickly when there is a high level of suspicion. The CDC has done an impressive job at providing information and educational handouts. Information specific to healthcare workers can be found here.
As Americans, we have felt removed from this situation, and it appears we have let our guards down. It is everyone's responsibility to educate themselves — not just first responders and emergency room personnel. Every healthcare worker is a part of the safety net of patient care and an integral part of the team. Healthcare workers cannot assume that others are attending to care. We all have a role.
Although systems are put in place to "capture" or "flag" patients who are at risk, it is only successful when the next step is taken — action and interventions. Just as patients are screened for fall risks in the hospital, it is not of use if interventions are not set forth to protect the patient.
Identification is just the first step. Sadly, it appears that the patient was screened, but for reasons unknown at this time, the information was not acted upon — in this case, for the safety of the public at large.
What is most disturbing about the information presented at the news conference was the fact that the nurse appears to be the key person to blame for this tragic misstep. Although the nurse certainly should have activated certain isolation practices based on his travel and presenting complaints, it is the responsibility of the other healthcare providers to accurately diagnose the patient based on all information gathered.
The medical record is the key tool for communication, but it must be read. Certainly, the nurse who owned the information could have gone to the providers and directed their attention. However, doesn't the diagnosing practitioner have a role in this also?
This is an excellent lesson on how all information needs to be treated as important. Communication is so pivotal in healthcare, and this will certainly be a lesson on how failed communication on many levels — education, data collection and information disbursement — can have serious consequences.
As healthcare providers, we have an obligation to educate ourselves on current epidemics. We owe it to our patients and the public to stay abreast of current health threats as we have learned they are just a plane ride away.
It will be interesting to see how this case unfolds. Hopefully, the hospital takes a better stance and recognizes that a system failed, not just communication of a nurse. There were many parties involved, and each will have to take responsibility.
But, more importantly, we need to learn from this experience if we don't want it to happen again.
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