As the Ebola contact list grows to more than 100 possible people in the Dallas area, the host family of the patient were ordered to stay home with police presence. The hospital that originally released the first patient now claims an EHR (electronic health record) glitch lead to the error.
According to the Dallas News, “the unusual confinement order was imposed after the family failed to comply with a request not to leave their apartment, according to Dallas County Judge Clay Jenkins.”
Tracing The Index Patient
The patient, now identified as Thomas Eric Duncan, did have exposure to Ebola according to his neighbors. HuffPo is reporting that he and several neighbors assisted a pregnant woman who later died. All the neighbors who assisted the woman later either became ill or died. CNN also is reporting that Duncan cared for a patient in their home.
The AP reports, on September 19th, as part of his departure requirements, Duncan filled out a form asking about exposure to Ebola. He answered no to all questions and had a temperature of 97.3 degrees before he boarded the plane. The form has questions which specifically ask if you’ve touched someone who has died, or cared for a patient with Ebola.
The list of possible people exposed is now about 100 and Dallas health officials are tracking people down for evaluation.
Physicians are actively discussing this inside Sermo in our Infectious Disease Hub. If you are an M.D. or D.O. we invited you to join the conversation.
Liberia May Prosecute
The Liberian President, Ellen Johnson Sirleaf, said early today that she will consult with lawyers about possible prosecution of Duncan when he returns to Liberia. In an interview with CBC Canada she said,
“With the U.S. doing so much to help us fight Ebola, and again one of our compatriots didn’t take due care, and so, he’s gone there and … put some Americans in a state of fear, and put them at some risk, and so I feel very saddened by that and very angry with him, to tell you the truth.”
Binyah Kesselly, board chairman of the Liberia Airport Authority, has said that he will prosecute Duncan for lying on the forms.
What Happened at Dallas Presbyterian?
Texas Health Presbyterian Hospital in Dallas released a report yesterday detailing the flow of care for Duncan. Duncan was initially treated and released on September 26th before returning two days later by ambulance for further care. They blamed the mistake on a potentially lethal combination.
- Duncan did not admit to being around patients with Ebola
- His early symptoms were consistent with a low-grade virus, with a temperature of only 100.1
- He did admit to travel history, but the information was entered into a screen not readily available to the doctor
The nurse doing the medical history asked and entered the information into the hospital’s EHR (electronic health record) system. However, the doctor never saw the travel note. According to HuffPo,
“The way the electronic health records at the hospital are set up, if a nurse enters travel history into the nursing workflow portion of the electronic health record, that information doesn’t automatically show up in the doctor workflow portion of the record”
Physicians within the Sermo community commonly complain about the notes fields in EHRs and how it can often be difficult to find information once entered into the system. There are several EHR systems available to physicians and medical facilities in the U.S.
Is Ebola Airborne?
The United Nations Secretary General’s Special Representative, Anthony Banbury recently said that Ebola could go airborne. Sermo community member Jim Wilson, MD pediatrician, infectious disease researcher and Vice President at Ascel Bio wrote when we read the statement, “we collectively groaned.”
“No one doubts the reality that Ebola virus is mutating. No one doubts the potential for this virus to pick of adaptations to the human host. But one thing that has been proven over and over again in the context of these public health crises and disasters is our inability to predict systemic outcomes based on genomic sequences.”
In other words, while it is possible for Ebola to mutate to an airborne virus it is highly unlikely at this point and saying so only encourages fear mongering. Wilson continues,
“Perhaps the UN feels a need to over-gun the warning in order to compel the international community to fulfill its promises of response. There is little doubt we are still in “hurry up and wait” response mode. But it erodes credibility of the entire operation to have a senior official made wild claims.”
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As a physician, how do you feel about the EHR glitch that might have exposed dozens of people? Do you think the nurse should have been more vigilant to track down the doctor and make sure he knew the situation? Do you think Duncan should be prosecuted either here or in the US for failing to disclose his possible exposure? What do you think about the possibility of Ebola going airborne?
The glitch is the EMR. Since moving to CPOE and computer documentation in the ED, there is less verbal communication. Everyone is plugged in front of a computer typing furiously the vase majority of their shift. Doctors and nurses do not talk to each other as frequently. “Its in the computer.”
Do we know if the patient even saw a physician? It’s entirely possible in this day of ACA and cost-cutting that he was triaged to a mid-level practitioner.