Ebola in Dallas

David Lawrance david.lawrance at GMAIL.COM
Tue Oct 7 11:47:23 UTC 2014


The interesting things to watch are those at the interfaces. One case
results in how many c!ose contacts? The procedures for cleaning up are
understood, but who in the community is trained and willing and able to do
it? Who will transport and accept wastes for terminal processing? Is the
permitting process simple or complex? How long does it take to put the
resources together to carry out the tasks?

The NYT has an article about relief supplies stuck at the dock for a month
in Sierra Leone for lack of issuance of paperwork.

A nurse in Spain is sick. How much pause will that give to other health
care professionals? Who staffs the late or third shift?

David
On Oct 6, 2014 3:28 PM, "Peggy Zuckerman" <peggyzuckerman at gmail.com> wrote:

> I agree that the issue of blame is not helpful, but the details as to
> where the system failed to pick up and transmit information will naturally
> have to involve people, record-taking-translating-transmitting-reading,
> operational errors and more.  Since there can be mistakes and omissions in
> many steps along the way, there have to be duplications of information, and
> way to winnow out the urgent issues.
>
> For example, if any intake system can be updated to collect Ebola/West
> Africa/Liberia data from this patient and and from the critical health
> alerts (that I would hope exist through the US)at any one time, and be able
> to change to reflect a measles outbreak in a neighboring state or school
> district, then those alerts would have value at all times.
> Doctor/nurse/patient/caregiver input is part of all of that, as should be
> data from the CDC, the state and county health systems. That may be
> built-in information that is not of high value at one time, but must rise
> to the surface at another time.
>
> Peggy Z
>
> On Mon, Oct 6, 2014 at 1:43 PM, Karen Cosby <kcosby40 at gmail.com> wrote:
>
>> How strange to follow this thread.  I thought we had grown past the
>> tendency to blame and shame each other.  I don't think any of us know all
>> the first hand details, yet we are quick to blame, and quick to take
>> offense.  There are bigger lessons to take from this.  And it will require
>> more than snap judgments to fix the real issues that are in such need of
>> solutions.
>>
>> On Mon, Oct 6, 2014 at 10:30 AM, Alan Morris <Alan.Morris at imail.org>
>> wrote:
>>
>>> As I have mentioned before, this is an example of the value of detailed
>>> computer decision-support tools.  Once data are acquired (by RN, MD,
>>> Patient with and iPone or iPad, telephone҆) they can drive rules.  This
>>> is
>>> clearly feasible across disciplines and cultures, but scalability is not
>>> yet tested.
>>>
>>> Alan H. Morris, M.D.
>>> Professor of Medicine
>>> Adjunct Prof. of Medical Informatics
>>> University of Utah
>>>
>>> Director of Research
>>> Pulmonary/Critical Care Division
>>> Sorenson Heart & Lung Center - 6th Floor
>>> Intermountain Medical Center
>>> 5121 South Cottonwood Street
>>> Murray, Utah  84157-7000, USA
>>>
>>> Office Phone: 801-507-4603
>>> Mobile Phone: 801-718-1283
>>> Fax: 801-507-4699
>>> e-mail: alan.morris at imail.org
>>> e-mail: alanhmorris at gmail.com
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>> On 10/5/14, 4:31 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
>>> >
>>> >To unsubscribe from the IMPROVEDX:
>>> >mail to:IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>> >or click the following link: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>> >
>>> >Address messages to: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>>> >
>>> >For additional information and subscription commands, visit:
>>> >http://www.lsoft.com/resources/faq.asp#4A
>>> >
>>> >http://LIST.IMPROVEDIAGNOSIS.ORG/ (with your password)
>>> >
>>> >Visit the searchable archives or adjust your subscription at:
>>> >http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
>>> >
>>> >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=IMPRO
>>> >VEDX&A=1"
>>> >target="_blank">
>>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SU
>>> >BED1=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>
>>>
>>
>>
>> ------------------------------
>>
>>
>> To unsubscribe from IMPROVEDX: click the following link:
>>
>> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
>> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>>
>> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair,
>> Society for Improving Diagnosis in Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>
>
>
> --
> Peggy Zuckerman
> www.peggyRCC.wordpress.com
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
>
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
>
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society
> for Improving Diagnosis in Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/








HTML Version:
URL: <../attachments/20141007/3013c095/attachment.html>


More information about the Test mailing list