It is with great sadness that I write about the Ebola patient case at a hospital in Dallas, Texas. The patient has now died. All healthcare providers would be well served by studying what happened in this case. In late September a man walked into a hospital with a fever, complaining of abdominal pain and a sharp headache. When the patient was asked whether he had nausea, vomiting, or diarrhea, he said “No.” At that time his symptoms, which were not severe, could have been associated with many infectious diseases, as well as many other types of illness. He was also asked if he had been around anyone who had been ill, to which he said “No” and if he had traveled outside the United States within the last four weeks. He responded that he had been in Africa. A nurse entered that information in the electronic medical record. From what we know it appears that he was sent home with antibiotics. The patient returned two days later saying he was worse and this time he was admitted to the hospital and placed into isolation with possible Ebola. Ultimately, the U.S. Centers for Disease Control released the information that this individual tested positive for Ebola and has now died of that disease.
Ebola scares us because it has a high mortality rate and its initial signs and symptoms are not unique. The current outbreak can and will be contained and extinguished but this will require a well-designed and executed international plan.
Is our current health care delivery system capable of creating and executing this plan? Well, everyone knows that we don’t have an international health care system. We have many national health systems of varying capabilities. A country like Sierra Leone, for example, doesn’t have a well-developed public health infrastructure or primary care system. In our own country our healthcare system has more capacity, but, the events in Dallas show that you can have extensive financial resources deployed in a healthcare system, but, have it poorly designed to meet a need of the community it serves.
In this case, the hospital in Dallas appears to have had a major “latent” error (hole in the Swiss Cheese) that was waiting to be part of a trajectory that would lead to the catastrophe of putting a patient with Ebola back out on the street. I am afraid that the very same latent error is present in many healthcare organizations throughout our country. That latent error is the absence of direct concise communication between members of the healthcare team. I should be cautious commenting on this case without all of the facts, but it appears that at least one team member knew that the patient had recently traveled from Africa and yet the patient was discharged from the emergency department only to be admitted later with Ebola, thereby having potentially spread the disease to multiple other individuals.
The knowledge of what happened in Dallas is a potential treasure for the rest of us in the US healthcare system. We must learn from this and redouble our efforts to operate as a high-functioning team with freely flowing information and people not afraid to speak up if they have a safety concern.
Physician Assistants WeekPlease join me in celebrating all GBMC physician assistants (PAs). This week is National PA week (Oct. 6-12) and is a time when PAs celebrate their profession and showcase the value they bring to today’s healthcare team.
A physician assistant (PA) is a nationally certified and state-licensed medical professional who begin their careers with rigorous education in a highly competitive field. Upon completion of a bachelor’s degree, prospective students must then attend an intense three year PA program and complete at least 2,000 hours of supervised clinical practice. They then must pass the Physician Assistant National Certifying Exam (PANCE), which is administered by the National Commission on Certification of Physician Assistants (NCCPA).
The PA staff at GBMC practice in many areas from the outpatient offices to the inpatient units in a wide variety of specialties. Please join me in thanking our PA’s for their hard work and for their important role in caring for our patients.