Tag: Ebola

The Public Health Enemy at the Gate

Feb 19, 2017• 6

By ARTHUR CAPLAN

President Donald Trump keeps getting kicked around in court when challenges are brought against his ban on travel from seven predominantly Muslim nations. Trump says he wants to halt the flow of people who might be planning attacks. What we cannot forget is that the kind of attack he has in mind is not confined to bombs and shootings. Trump is terrified that immigrants bring diseases with them. If racism fails, public health will likely afford Trump the rationale he seeks for making it difficult for those he does not like to enter our country.

The president is a self-described germaphobe. He has doubts about vaccines. He likely does not wake up every day to thrill at the latest advances in science. This is a president who might possibly let an infectious disease do what he has so far not been able to accomplish by impugning the country or religion of immigrants he doesn’t like: provide the basis for a ban.

The threat of a pandemic is yet another avenue he could possibly embrace to create a Fortress America. He might demand more walls, quarantine stations at airports and one-way tickets home for every potential human vector — including the frail, kids and pregnant women. No one who is sick, might be sick or who can be smeared as the source of Americans getting sick would get in.

Pandemic flu, Zika, yellow fever, West Nile and a host of other maladies are likely to keep popping up over the next four years. The news media are great at stoking fear about all of them. Public officials are ill-prepared to know what to do about any of them.

Got an Infection? Good Luck Finding an ID Doctor

Mar 15, 2015• 2

By PHILIP LEDERER, MD

BOSTON, Ma. — It was Christmas Day. I was on call at the hospital and was waiting for my wife and 6-week-old son to come so we could eat lunch together. She was bringing kimbap, sweet potatoes, and avocados. But then my pager buzzed.

On the phone was a hospitalist physician.

“Is this ID? We have a new consult for you,” she said. “This man has a history of dementia. For some reason he has a urinary catheter to empty his bladder. We gave him an antibiotic, but now his urine is growing a resistant bacteria.”

I sighed. Yet another catheter associated urinary tract infection.

I walked up the stairs to his hospital room. He was bald, thin, and sitting alone in bed. The peas and fish on his tray were untouched. There were no gifts or tree in his room. I washed my hands, put on gloves and a yellow isolation gown, and introduced myself.

“How are you?”

“Ok, I guess,” he replied.

“Do you know where you are?”

“I’m not sure.”

“You are in the hospital. Do you know what day today is?”

2014 A Healthcare Odyssey

Dec 30, 2014• 13

By SAURABH JHA, MD

It might have been the best of times. It could have been the worst of times. But 2014 turned out to be the most mediocre of times. Here’s a recap.

Why did Sebelius resign?

Never make a promise to your kids that you can’t keep. And never project the number of people who will sign up for the exchanges and change your mind, unless you are the CBO. If you have read about the problem of uninsured in the US you might have considered CBO’s original projection that seven million people will sign up on the exchanges within six months of open enrollment a tad conservative. Weren’t there millions and millions, forty million apparently, gagging for healthcare coverage?

The CBO revised the projection to six million in February with the projection date of March 31^st coming tantalizingly close. Towards the end of March you could hear the cheers of “roll baby, enroll” getting louder.

On April Fools’ Day, the ACA remained intact, the country had not descended in to civil war and some eight million had signed up for Obamacare.

Ebola and the Information Flow Challenge

Oct 28, 2014• 3

By TODD ROTHENHAUS

The Ebola crisis in Texas has tested our nation’s health care system in many ways, exposing weaknesses and potential breakdowns. In particular, the incident with the first diagnosed Ebola patient at Texas Health Presbyterian underscores a fundamental issue with information liquidity between providers, their care teams, and across the continuum of care. The ability to share information effectively is critical not just in responding to health care crises like Ebola — but also in delivering great, cost-effective care.

As athenahealth CEO Jonathan Bush said in an interview with CNBC earlier this month:

“The worst supply chain in our society is the health information supply chain. It’s just a wonderfully poignant example, [a] reminder of how disconnected our health care system is. … The hyperbole should not be directed at Epic or those guys at Health Texas. The hyperbole has to be directed at the fact that health care is islands of information trying to separately manage a massively complex network.”

Did CDC laxness on one infection help spread another?

Oct 25, 2014• 6

BY MICHAEL MILLENSON

There’s an infection that afflicts thousands of Americans yearly, killing an estimated one in five of those who contract it, and costs tens of thousands of dollars per person to treat. Though there’s a proven way to dramatically reduce or even eliminate it, the Centers for Disease Control and Prevention (CDC) inexplicably seems in no hurry to do so.

Unlike Ebola, this infection isn’t transmitted from person to person, with the health care system desperately racing to keep up. Instead, it’s caused by the health care system when clinicians don’t follow established anti-infection protocols – very much like what happened when Texas Health Presbyterian Hospital encountered its first Ebola patient. That hospital’s failure flashes a warning sign to all of us.

The culprit in this case is called CLABSI, short for “central-line associated bloodstream infection.” A central line is a catheter placed into a patient’s torso to make it easier to infuse critical medications or draw blood. Because the lines are inserted deep into patients already weakened by illness, an infection can be catastrophic.

CLABSIs are deadlier than typhoid fever or malaria. Last year alone they affected more than 10,000 adults, according to hospital reports to the CDC, and nearly 1,700 children, according to an analysis of hospital discharge records. The infections also cost an average of nearly $46,000 per patient to treat, adding up to billions of dollars yearly.

At one time, CLABSIs were thought to be largely unavoidable. But in 2001, Dr. Peter Pronovost, a critical care medicine specialist at Johns Hopkins, simplified existing guidelines into an easy five-step checklist with items like “wash hands” and “clean patient’s skin with an antibacterial agent.” Hopkins’ CLABSI rate plunged.

Is It Possible to Catch Ebola From the Media?

Oct 24, 2014• 30

By JOHN IRVINE

That pesky Ebola bug is not done with us yet.

Apparently not satisfied with inflicting havoc in Texas for two weeks and causing a major panic, the publicity-hungry Ebola virus set its sights on the media capital of the world on Thursday.

The latest Ebola case is a New York City Doctor. A specialist in international medicine at New York Presbyterian Hospital, Dr. Craig Spencer had been working with Ebola patients for the French relief agency Doctors Without Borders.

New York City health officials are conducting contact tracing to find people who may have had contact with Dr. Spencer.

The bad news?

New York City being New York City, Spencer took the the subway from his apartment on West 143th street in Harlem to a Brooklyn bowling alley the night before his fever spiked. That’s led to speculation that he may have inadvertently exposed a lot of people. Public health health officials are now tracing Spencer’s contacts to find potential “high risk” cases.

Our talking points:

Is It Possible to Catch Ebola on the Subway?

No. Yes. Maybe.

Unfortunately, in reality we don’t know, although we’re pretty sure we do. Current CDC guidelines are based on the assumption that Ebola only becomes contagious when symptoms present and the patient enters the high fever stage.

Via Controversies at Hospital Infection Prevention:

Those at risk for Ebola are healthcare workers who have cared for Ebola patients (whether here or in West Africa). Not mall-goers, bowlers, subway riders, or those who might have been in an airport terminal on the same day as an asymptomatic Ebola patient. The greatest transmission risk is borne by those who provide direct care for Ebola patients during severe illness, when viral shedding is very high.

There’s a lot of evidence to support this argument. There have been cases of symptomatic Ebola patients traveling by airplane, bus and other modes of transportation without spreading the disease. That’s somewhat reassuring.

On the other hand, it is not exactly compelling statistical evidence of anything other than that some people travelled with an Ebola patient and did not develop Ebola.

We need to work with much larger numbers before we know for sure. The good news?

Now that Ebola has arrived in a city of eight million people, we’re now going to have them.

Throwing the EHR Under the Bus …

Oct 19, 2014• 59

By JOHN IRVINE

Given what is now known about how the case of Thomas Eric Duncan at Texas Health Presbyterian was handled, the attempt to blame the hospital’s electronic health record for the missed diagnosis sounds pretty lame.

But people are still doing it:

Screen Shot 2014-10-18 at 10.43.43 AM

Critics of electronic medical records have found a case they will be talking about for years.

Consider this argument from Ross Koppel and Suzanne Gordon:

While it is too early to determine what precisely happened in this case, it is not too early to consider the critical issues it highlights. One is our health care system’s reliance on computerized technology that is too often unfriendly to clinicians, especially those who work in stressful situations like a crowded emergency room. Then there are physicians’ long-standing failure to pay attention to nurses’ notes. Finally, there is the fact that hospitals often discourage nurses from assertively challenging physicians.

Long promised as the panacea for patient safety errors, electronic health records, in fact, have fragmented information, too often making critical data difficult to find. Often, doctors or nurses must log out of the system they are on and log into another system just to access data needed to treat their patients (with, of course, additional passwords required). Worse, data is frequently labeled in odd ways. For example, the results of a potassium test might be found under “potassium,” “serum potassium level,” “blood tests” or “lab reports.” Frequently, nurses and doctors will see different screen presentations of similar data, making it difficult to collaborate.

Continue reading…

Data for Health: Coming to a Town Near You …

Oct 16, 2014• 13

By MICHAEL PAINTER, MD

We have some questions for you—questions, that is, about health information. What is it? Can you get it when you need it? What if your community needed important information to make your town or city safe or keep it healthy? How about information about your health care? Can your doctors and nurses get health care information about you or your family members when they need it quickly?

I came across a recent Wall Street Journal article about a remarkable story of health, resilience and survival in the face of an unimaginable health crisis—a Liberian community facing the advancing Ebola infections in their country got health information and used it to protect themselves. When the community first learned of the rapidly advancing Ebola cases coming toward them, the leaders in that Firestone company town in Liberia jumped on the Internet and performed a Google search for “Ebola”.

Angry Nurses Tell of Ebola Patient’s arrival at Texas Hospital

Oct 15, 2014• 125

By THCBist

A group of nurses at Texas Health Presbyterian has come forward with a very different picture of what happened when Liberian Ebola patient Thomas Duncan arrived at the hospital with Ebola-like symptoms on September 28th. If true, the allegations are certainly unsettling.

In an unusual move, the nurses spoke anonymously to the media, conducting a blind conference call in which none of the participants were identified.

After arriving at the emergency room with a high fever and other symptoms of the disease , the nurses said the patient was kept in a public area, despite the fact that he and a relative informed staff that he had been instructed to go to the hospital after contacting the Centers for Disease Control in Atlanta to report a possible case of Ebola.

Six Sigma vs Ebola

Oct 12, 2014• 18

By SAURABH JHA, MD

If another case of Ebola emanates from the unfortunate Texas Health Presbyterian Hospital, the Root Cause Analysts might mount their horses, the Six Sigma Black Belts will sky dive and the Safety Champions will tunnel their way clandestinely to rendezvous at the sentinel place.

What might be their unique insights? What will be their prescriptions?

One never knows what pearls one will encounter from ‘after-the-fact’ risk managers. I can imagine Caesar consulting a Sybil as he was being stabbed by Brutus. “Obviously Jules you should have shared Cleo with Brutus.” Thanks Sybil. Perhaps you should have told him that last night.

Nevertheless, permit me to conjecture.

First, they might say that the hospital ‘lacks a culture of safety which resonates with the values and aspirations of the American people.’

That’s always a safe analysis when the Ebola virus has just been mistaken for a coronavirus. It’s sufficiently nebulous to never be wrong. The premise supports the conclusion. How do we know the hospital lacks culture of safety? ‘Cos, they is missing Ebola, innit,’ as Ali G might not have said.

They would be careful in blaming the electronic health record (EHR), because it represents one of the citadels of Toyotafication of Healthcare. But they would remind us of the obvious ‘EHRs don’t go to medical school, doctors do.’ A truism which shares the phenotype with the favorite of the pro-gun lobby ‘guns don’t kill, people kill.’