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“What the Ebola Virus and Sen. Barbara Boxer Can Teach Us About Health Care Systems” – Did you read it?


iStock | Ridofranz

iStock | Ridofranz

In a recent piece for the Huffington Post, Saquib Rahim, MD, shared how he thinks healthcare systems can learn from the Ebola virus cases and a report from Senator Barbara Boxer’s office. See if you agree with what he has to say in the excerpts below.

He opens by saying:

Medical errors are a paramount concern in health care, and often they are a byproduct of ineffective processes and systems within hospitals, operating rooms and clinics. The recent Ebola case in Dallas is a stark reminder of that fact. On October 8 at Texas Health Presbyterian Hospital, Thomas Eric Duncan became the first person in the U.S. to die from the Ebola virus. Despite informing an emergency room (ER) nurse that he had recently traveled from Liberia, Mr. Duncan was sent home with a presumed viral illness after his initial presentation to Texas Presbyterian. The attending ER physician never became aware of this recent travel, for his workflow in the electronic health record (EHR) was separate from that of the nurse.

Texas Presbyterian released a statement on October 2, acknowledging there was a miscommunication between the physician and nurse due in part to the design of the EHR. Since then, two nurses involved in Mr. Duncan’s care contracted (and have recovered from) the Ebola virus themselves, and outlets like Vox have questioned if the CDC’s Ebola treatment protocols were too complicated for proper adherence.

How he sees it:

From my experience having worked in over fifteen different hospitals/clinics since beginning medical school, errors of communication and complication are far from rare. We only heard so much about the Dallas Ebola case because of its high profile and the gravity of the virus. This past summer, the office of Senator Barbara Boxer (D-CA) published a report on medical errors in America. The report cites a 2013 Journal of Patient Safety article that estimates between 210,000 and 440,000 Americans die every year due to medical errors and other preventable harm at hospitals—or the equivalent of a jumbo jet crashing every day with no survivors. By that count, medical errors can be considered the nation’s third-leading cause of death, trailing only heart disease and cancer.

As the Dallas Ebola case highlights, one major issue underlying medical errors is that many practices and workflows in health care are overly complicated, clumsy and broadly inefficient. Why would a nursing workflow with vital patient information not be designed to show up in the physician’s workflow (and vice versa)? And why would that vital information not have been flagged so it was essentially impossible to ignore?

How he thinks we can fix it:

The prevalent culture in health care is to create workarounds when complications arise rather than fixing the root problem. Issues are addressed on an ad hoc, individual basis, over time leading to patchwork processes without consideration for the overall system. Instead, I would argue health care needs more standardization, automation and evidence-based protocols. Common processes in health care should function very much like an assembly line. Each step should be clearly defined with appropriate resources available, and every participant should have well understood responsibilities.

Every field has areas of inefficiency, but health care may be worse than most. And unlike most other fields, the ramifications involve personal safety and quality of health. Patients and the public usually only hear about mistakes when they lead to harm, which luckily is a much smaller subset of total mistakes. However, Sen. Boxer’s office points out that mistakes are still far too common, and the recent Dallas Ebola case has brought health care operations to the forefront of media coverage.

Now is the time for medical communities everywhere to examine existing processes critically, pursue thoughtful advances in how we deliver care and promote a culture that engages staff in the improvement process. Taking care of patients is not only about the therapies we provide, but also having the most effective care delivery systems possible. By that metric, American health care still has significant room to grow.

Read his full story over on the Huffington Post. Then, in the comments below, tell us what you think about the post and whether or not you agree with him.

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