Assigning Blame


ER Nurses, Doctors and Techs. Can you tell the difference?

A classic example of how "shit rolls downhill"...

DALLAS (AP) - A Dallas emergency room sent a man with Ebola home last week, even though he told a nurse that he had been in disease-ravaged West Africa, and officials at the hospital are considering if they would have acted differently had the entire medical staff been aware.

The patient explained to a nurse last Thursday that he was visiting the U.S. from Africa, but that information was not widely shared, said Dr. Mark Lester, who works for the hospital's parent company.  "Regretfully, that information was not fully communicated" throughout the medical team, Lester said. Instead, the man was diagnosed with a low-risk infection and sent home.

When in doubt, when trying to cover your ass...blame the nurse.

I 'get' that hospital spokespersons are under a great deal of pressure to explain how Ebola was not suspected in the first ER visit. I  'get' that the community has a right to know where the lapse occurred. However, I doubt seriously that in 24 hours, there was time for an in depth review of this case before making the nurse a scapegoat.

For those of you who are not familiar with working in an ER... It is comprised of a multidisciplinary team of nurses, doctors, techs, clerks and therapists who work together in order to accomplish their goal. They literally risk their lives caring for the physically, mentally and emotionally ill, 12 hours a day,every day they work.  Exposure to physical violence and a host of communicable diseases such as Tuberculosis, Hepatitis, HIV (and now, Ebola) keeps everyone on their toes in this dynamic and many times chaotic environment.

True Story...
In the first hour of a 12 hour night shift,  I recall approaching the triage desk when my arm was grabbed by a strange man who came from behind me. He threw me up against the wall as he demanded to know where his "kid was at". Security soon intervened but despite the fact that I had been assaulted, I continued my task and called my next patient. After completing my nursing assessment and documenting the details, I stepped outside of the room where I assisted in apprehending a naked woman running down the hallway. Walking away from that scene and attempting to shake off the bad ju-ju of the night, I was confronted by Dallas Fire Rescue Paramedics who presented me with a huge man, actively spewing bright red was going to be a long night.

Can you spot where a communication failure could happen here? And this was my experience only. It does not detail the experience of the doctor, techs or therapists in that same hour.Failures in communication happen. It's the nature of the ER beast.

Assigning blame to any one member of the ER team is a slippery-slope. It creates an 'us' against 'them' mentality and has the potential to fracture a department.

Instead of finger-pointing, perhaps a response that included an explanation of the complexities involved in this volatile case and support of the Presby Dallas ER Team would have been most appropriate as I am confident that the intent was to deliver the best care possible.

Update...After further investigation, Presbyterian Dallas hospital cites the failure in communication to be the Electronic Health Record ...not the nurse (ahem). Texas Health Presbyterian Officials Explain Patient Release
WFAA:Janet St. James8:12 a.m. CDT October 4, 2014

And Yet Another Update: ... and now, the administration admits that the ER Doc "did have access to his travel history after all" . Presby Dallas Hospital Administration...You're killing me.

Hospital: Ebola Patient in Critical Condition
(In part)
"The hospital's explanation about what they knew about his travel history has changed in the time since his diagnosis was revealed on Tuesday. Federal health officials have advised hospitals to take a travel history for patients with any Ebola-like symptoms.
When Duncan's diagnosis was first disclosed, the hospital said it wasn't till he came back Sunday that they discovered he had been in West Africa. The hospital later acknowledged that Duncan had told a nurse his travel history on his first visit but said the information hadn't been fully communicated to the whole team.
On Thursday, the hospital elaborated by saying that a flaw in the electronic health records systems led to separate physician and nursing workflows and that the doctor hadn't had access to Duncan's travel history.
But the hospital issued a statement late Friday saying that the doctor who initially treated Duncan did have access to his travel history after all.
Hospital spokesman Wendell Watson said Saturday he could provide no further details, saying, "We're still looking into the entire chain of events."

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Kory said...

well said. My thoughts were similar. I know what the reality of what they were likely in that night and it is sad that those who have no idea are crucifying them.

the unimpowered, nameless, faceless RN said...

Absolutely. Let's also talk about the patient. In the event that I had traveled from Africa after physically carrying a patient that DIED from Ebola and then developed a fever within 21 days, you can BET YOUR SWEET ASS I would be telling everyone at the hospital that I was EXPOSED TO EBOLA. I wouldn't stop at mentioning the name of some country in Africa that most people had never heard of until 2 days ago to ONE person. ONE. SERIOUSLY. This guy is more
To blame than ANYONE.

joanyspot said...

Dear T.U.N.F.RN - I'm with ya! Throughout my career, I have been blown away by the fact that many times, my patients are tight-lipped about information crucial to making the correct diagnosis yet somehow expect the HCW to just figure out what's going on with them. Go figure. Thanks for your comment.

joanyspot said...

Thanks for stopping by, Kory.

EDMGR said...

Amen Joan. You said there but for the Grace of God go I. My heart goes out to the entire Presby team. Few understand the challenges and risks we face every shift.

Your ICU pharmacist. ;) said...

And then it ends up being an EHR glitch. Also interesting is how quickly that glitch was corected. So thankful that we have ED staff WILLING to do what they do, day in and day out. You are missed, Joanie!

joanyspot said...

EDMGR: "But for the grace of God, go I" You have inspired another blog post. Thank you.

joanyspot said...

To My ICU Pharmacist...Miss you too!