Separate Work Flows Let Ebola Slip By


As I hadn’t been preaching the perils of industrialized medicine enough, here may be one of the best examples, which I will now make into a joke (i.e. why did the chicken cross the road, etc.).

“Why didn’t the nurse tell the doctor the Liberian patient was at risk for Ebola?  (wait for it).  Because they have “separate” work flows and no one talks to each other since the advent of EMRs. ”

According to this article (picture above is NOT the doctor and nurse):

The hospital said the Liberian man’s travel history was located in the nurses’ portion of the EHR, but — “As designed, the travel history would not automatically appear in the physician’s standard workflow.”

Of course, the nurse could have actually talked to the doctor.  But that doesn’t happen anymore!!  They are too busy typing in bullshit to think.  The past year I had to retrain the MAs at the place I was working to actually talk to me about every patient instead of just leaving a note for me to read.  The nuances and questioning back and forth give better care and allows two people to hear the story.  You know, like in the good old days.

Here is Stella Fitzgibbons (a frequent contributor to this blog) thoughts on this as she emailed me:

The news media now tell us that the index patient in Dallas had close contact with a very sick febrile woman in one of the countries where the virus is now epidemic. He answered “No” to immigration officials’ questions about contact with the sick, exposed his relatives in Dallas, and when he got sick never offered any reason to worry about him. But he DID tell the ER triage nurse he had come from Liberia, and now the hospital is trying to claim that the nurse did not “fully communicate” that fact.

What exactly was the triage nurse supposed to do, hit the doctor over the head? Slap a red flag on the chart?

And was the nurse’s note in an easily legible form, or was it buried in an EHR that was shoved down doctors’ and nurses’ throats by an administration focused on cutting costs? Was the ER doctor even familiar enough with the local software to check the information available to him? And, of course, how much pressure was the staff under to “improve throughput” while minimizing admissions of uninsured patients?

Watch and see who gets the blame.

(AN HOUR LATER) …on CBS Evening News: the ER nursing electronic records “failed to interface with the doctors'”. Here’s hoping our voices will be heard: EHRs are not just burdensome but a poor one can make patient care worse.

Ten years ago the triage nurse would have filled out a paper format went onto a chart the doctor could read without logging onto a software system that he might or might not know well. When are doctors AND nurses going to put our numbers to use and speak for patient care?


59720cookie-checkSeparate Work Flows Let Ebola Slip By