Ebola in Dallas

Albert Wu awu at JHU.EDU
Mon Oct 6 14:28:30 UTC 2014


Agreed

On the other hand, there is a substantial amount of required charting
these days in nurses notes that can be difficult to sift through en route
to the mention of West African travel

Chart junk is also a problem in physician records, especially with the
rise of cut-and-paste
Albert


Albert W. Wu, MD, MPH, FACP
Professor and Director
Center for Health Services & Outcomes Research
Johns Hopkins Bloomberg School of Public Health
624 N Broadway Room 653
Baltimore MD 21205
(410) 955-6567 / fax (410) 955-0470
Mobile (410) 978-1539






On 10/6/14, 10:09 AM, "Baumann, Andrea" <baumanna at MCMASTER.CA> wrote:

>Interesting put down on nurses notes ...
>
>Andrea Baumann, Associate V-P, Global Health, Faculty of Health Sciences
>Director, WHO Collaborating Centre in Primary Care Nursing & Health Human
>Resources 
>Scientific Director, McMaster Site, NHSRU
>1280 Main Street West, MDCL 3500
>Hamilton, Ontario    Canada L8S 4K1
>tel   +1.905.525.9140 ext. 22581   |   fax  +1.905.522.5493
>
>
>-----Original Message-----
>From: Swerlick, Robert A [mailto:rswerli at EMORY.EDU]
>Sent: Monday, October 06, 2014 9:34 AM
>To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>Subject: Re: [IMPROVEDX] Ebola in Dallas
>
>A busy ED physician faces a deluge of information and the ratio of signal
>to noise is small. The electronic health record used is not such much an
>information management tool. The key pieces of information needed to
>avoid the most recent embarrassment are hidden in various nooks and
>crannies of the record. I am reminded of reading the series of "Where's
>Waldo" books to my children at bedtime, desperately trying to find Waldo
>in the mass of tiny cartoon characters. The only difference is I don't
>even know what I am looking for in the medical record.
>
>Why didn't the ED physician read the nurses notes? The same reason s/he
>did not read every other page in the record. Whether justified or not, I
>suspect that the nursing notes may be filled with lots of extraneous
>information (noise) which seldom had been essential to assimilate to make
>decisions.
>
> Industries which have gone further in terms of cracking this information
>management nut have figured out ways of putting important information in
>front of key decision makers when they are called upon to make decisions.
>As we delegate information collection to other parties, this is going to
>become an even larger issue.
>
>Bob Swerlick
>
>-----Original Message-----
>From: Joe Graedon [mailto:jgraedon at GMAIL.COM]
>Sent: Sunday, October 05, 2014 8:43 PM
>To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>Subject: Re: [IMPROVEDX] Ebola in Dallas
>
>Guessing a very busy ER and a harried MD made a quick decision that
>turned out to be wrong.
>
>Here is our take on the passing of the buck:
>
>http://www.peoplespharmacy.com/2014/10/04/delayed-diagnosis-of-ebola-in-da
>llas-reveals-fundamental-flaws/
>
>Joe Graedon
>
>On Oct 5, 2014, at 6:31 PM, David L Meyers <dm0015 at ICLOUD.COM> wrote:
>
>> It appears that the cause of improving diagnosis in medicine was given
>>an unfortunate boost in Dallas this week with the (mis)handling of the
>>nation's first case of ebola both at the clinical and public health
>>levels, that is already having risk management and public policy
>>effects.  With respect to the actual care of the patient, who was not
>>diagnosed until his second ED visit several days after his first one to
>>the same ED, the full story remains to be elucidated, but we've
>>witnessed the painful release of information followed by corrections and
>>restatements that too often characterize events of this sort.
>>
>> Initially, a nurse seemed to be the culprit blamed for obtaining
>>critical information about travel history from the Liberian patient
>>recently arrived in Dallas from Lagos via Brussels and Washington and
>>not passing it on the health care team or following the CDC guidelines
>>for handling such patients, said to be in place at the hospital.  Next,
>>blame focused on the failure of the EHR to properly communicate
>>information between the nurse and subsequent providers including the
>>treating physician. The latest information seems to be that the
>>physician had the information and made a wrong decision regarding
>>diagnosis, management and disposition; whether s/he acquired relevant
>>history independently or from the EHR is not clear.
>>
>> More information and analysis is trickling in and it will be sometime
>>before most of the facts are known, but it is clear there were human
>>errors and system errors which contributed to the situation. This may
>>wind up being the most studied case of diagnostic error to date with the
>>greatest potential to alter how the public sees this problem.  I imagine
>>the IOM committee now addressing this subject will have some very
>>instructive material to work with.  Root cause analysis anyone?
>>
>> Here's a chronicle of the events as pieced together by the Dallas
>> Morning News.  Interesting reading.
>> http://www.dallasnews.com/news/metro/20141004-dallas-ebola-case-shows-
>> even-sound-plans-can-fail-spectacularly.ece
>>
>>
>>
>>
>>
>>
>> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair,
>> Society for Improving Diagnosis in Medicine
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