Ebola in Dallas

Swerlick, Robert A rswerli at EMORY.EDU
Mon Oct 6 14:41:09 UTC 2014


This was not meant to be a put down of nurses or their notes. Perhaps I should have stated that the perception is that there are pieces of information in the EHR that not essential to decision making and for the most part, no one gets burned when they are not reviewed.  I can attest to this in the ambulatory world. Look at meaningful use mandates. The one size fits all has resulted in our nursing staff being pulled away from activities we deem important to do things where we perceive less value brought to patients and physicians.  Some of this perception appears to be correct.  

In my opinion, the biggest challenge regarding the electronic medical record is getting quality data into the system and getting past this challenge will require enlisting an army of people other than physicians (particularly nurses) to enter information. The next challenge will be to digest and present this information to decision makers at the point of service to support their decisions.  Otherwise, important information will go unviewed with likely adverse outcomes. 

RAS

-----Original Message-----
From: Baumann, Andrea [mailto:baumanna at mcmaster.ca] 
Sent: Monday, October 06, 2014 10:09 AM
To: Society to Improve Diagnosis in Medicine; Swerlick, Robert A
Subject: RE: [IMPROVEDX] Ebola in Dallas

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-dallas-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
>
> To unsubscribe from the IMPROVEDX list, click the following link:<br> 
> <a 
> href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=I
> MPROVEDX&A=1"
> target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.ex
> e?SUBED1=IMPROVEDX&A=1</a>
> </p>






Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br> <a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>

________________________________

This e-mail message (including any attachments) is for the sole use of the intended recipient(s) and may contain confidential and privileged information. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this message (including any attachments) is strictly prohibited.

If you have received this message in error, please contact the sender by reply e-mail message and destroy all copies of the original message (including attachments).






Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine

To unsubscribe from the IMPROVEDX list, click the following link:<br> <a href="http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1" target="_blank">http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1</a>
</p>










More information about the Test mailing list