A huge mistake by doctors at Texas Health Presbyterian Hospital in Dallas has created a firestorm of controversy about electronic medical records. When Thomas Eric Duncan arrived at the emergency room on September 25th he complained of a fever (100.1 degrees F.), abdominal pain, a bad headache, as well as reduced urination. Doctors diagnosed him with a routine viral infection and sent him home with antibiotics. (Since antibiotics do nothing for a viral infection, this was a huge mistake.)
The hospital tried to explain its tragic mistake on Thursday, Oct 2nd. That statement noted that a nurse had asked Mr. Duncan about his recent travel history and he responded that he had traveled from West Africa. This information was entered into the electronic medical record. The hospital initially told the media that this information was situated in the “nursing workflow” part of the electronic health record (EHR) and that it never made it to the “doctor workflow” section of the EHR. The hospital called this a flaw in the way in which the nursing and doctor information interacted electronically.
Mr. Duncan was brought back to the hospital on September 28th by ambulance. Soon after his arrival the hospital discovered that it had a medical crisis on its hands. Lots of people, including schoolchildren, had been exposed unwittingly to the Ebola virus.
How Did Doctors Miss the Ebola Diagnosis?
How did the initial diagnostic mistake happen? Was this a flaw in the electronic record system or was it a failure of communication between nurses and doctors? Who screwed up?
The original statement by hospital administrators seemed to let physicians off the hook. If the doctors didn’t see Mr. Duncan’s travel history and the key word Africa, they could not be blamed for making such a serious medical mistake.
Hospital Backpedals on Blame
The hospital changed its story on Friday, Oct. 3rd. In this revision the hospital stated:
“We would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient’s travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician’s workflow.
“There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event.”
We have no idea what went on behind the scenes at Texas Health Presbyterian Hospital in Dallas. One could speculate that the people who developed the electronic health record did not want to take the fall for this serious medical mistake. The initial statement that there was a “flaw” in the EHR might not have gone over well with these folks.
The nurse, who presumably followed protocol by asking the right travel questions and entering the data into the system, did not want to be thrown under the bus either.
Why Didn’t Doctors Read Nurse’s Note?
The retraction by hospital administrators admitted that physicians, as part of the “full care team” had access to the travel history of Mr. Duncan. In other words, there was “no flaw” in the electronic health record. What the hospital did not say was that the doctors at their hospital blundered badly when they released Mr. Duncan back into the community. It seems, in hindsight, that they did not pay close attention to the nurse’s note in the medical record.
This has made headlines because the deadly Ebola virus is in the news. But diagnostic errors happen every day in hospitals across the country. It is estimated that anywhere from 40,000 to 225,000 people die annually because of these mistakes. In many cases they go unrecognized and unreported. It’s the third rail in medicine.
Busy emergency room doctors may believe that they don’t have time to read all the nurses’ notes in the electronic health record. This incident shows they cannot afford to skip such critical information. Patients and their families must ask some important questions to try to reduce the epidemic of misdiagnoses. Here is a list taken from our book, Top Screwups Doctors Make and How to Avoid Them:
Top 10 Questions to Reduce Diagnostic Disasters:
Next time you see a health care provider try asking some of the following questions. You might be surprised how often a physician has not listened carefully to your concerns or has missed something critical.
- What are my primary concerns and symptoms?
- How confident are you about this diagnosis?
- What further tests might be helpful to improve your confidence?
- Will the test(s) you are proposing change the treatment plan in any way?
- Are there any findings or symptoms that don’t fit your diagnosis or that contradict it?
- What else could it be?
- Can you facilitate a second opinion by providing me my medical records?
- When should I expect to see my test results? Will you call with them, or will they come by mail or electronically?
- What resources can you recommend for me to learn more about my diagnosis?
- May I contact you by e-mail if my symptoms change or if I have an important question? If so, what is your e-mail address?
For more information, see today’s post on a potential cure for Ebola virus.
