Dallas Ebola patient Thomas Eric Duncan did tell a hospital nurse that he had been in Africa when he first visited the hospital with a fever and other symptoms, but due to a flaw in the hospital’s electronic health record workflows, that travel history was not communicated to physicians at the hospital, according to newly released information.
Texas Health Presbyterian Hospital Dallas released a statement Thursday (Oct. 2) night explaining the chain of events that occurred when Duncan first visited the emergency department on Sept. 25; the information was released “in the interest of transparency,” and with Duncan’s permission. Duncan was sent home after his initial visit to the emergency department, but went back to the hospital on Sept. 28 by ambulance. He is currently at the hospital in serious condition.
The hospital has been criticized for the lapse in communication since it was brought to light that Duncan had been sent home after seeking care for his illness. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN that “it was a mistake. They dropped the ball.”
According to the hospital statement, when Duncan first arrived in the emergency department, his symptoms were documented. He had a temperature of 100.1 degrees Fahrenheit, two days of abdominal pain, decreased urination and a sharp headache — however, none of these symptoms were specific to Ebola and could have been a sign of another disease. He replied “no” when asked if he had nausea, diarrhea or vomiting, and overall, his symptoms were not considered severe.
Duncan was also asked if he had been around someone who was ill, according to the hospital, and he answered no. When asked about his travel history over the last four weeks, he said he had traveled to Africa. This information was entered into his electronic health record by the nurse.
According to the statement, doctors and nurses all followed the necessary protocols when administering to a patient with suspected communicable disease. However, 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.
Read the hospital statement below:
Protocols were followed by both the physician and the nurses. However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case. In our electronic health records, there are separate physician and nursing workflows.
The documentation of the travel history was located in the nursing workflow portion of the EHR, and was designed to provide a high reliability nursing process to allow for the administration of influenza vaccine under a physician-delegated standing order. As designed, the travel history would not automatically appear in the physician’s standard workflow.
As result of this discovery, Texas Health Dallas has relocated the travel history documentation to a portion of the EHR that is part of both workflows. It also has been modified to specifically reference Ebola-endemic regions in Africa. We have made this change to increase the visibility and documentation of the travel question in order to alert all providers. We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola.