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One Failure Point--One Low-Tech Solution [Oct. 4th, 2014|03:34 pm]
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So it seems that other hospitals in oither states using the same software have, potentially, the same problem that Texas Health Presbyterian Hospital found in its software: there is no way to put a big whopping flag on the intake chart to indicate a known serious risk.   Programmers are no doubt downing coffee and chocolate and trying to modify the software without crashing everybody's system (which would not be good.)

But there's a fast, cheap, effective way to deal with this, says the writer who lives on both sides of the high tech/low-tech divide.  (No dishwasher, no smartphone, but computers and high-speed internet.)

Bright-colored (I suggest yellow, the color of the traditional plague flag--bright, easily noticed if it falls to the floor, etc.)  3x5 cards easily obtained in any office supply store, plus a stamp that says "Priority", an indelible marker (probably already at the ER intake desk) .  

Step one:  Hospital prints out a sheet to be taped to the staff side of the intake desk.   It reminds staff to ask specifically about travel  or residence in Guinea, Sierra Leone, or Liberia within the past 21 days.  Staff doesn't have to remember which countries--it's right there in front of them.   At the foot of the sheet is the in-hospital number they're to call if they "card" someone.

Step two:  Upon getting a positive answer to the question,  staff person writes patient's name on one card and hands it to the patient, asking the patient to wait right there.  Staff person clips second card to clipboard; if patient used that clipboard to fill out information, use the same clipboard.. 

Step three: Staff person 1 calls the contact number that will immediately initiate response to possible Ebola patient.   Upon arrival of team to ER waiting area, staff person 1 hands off clipboard to nurse or doctor, followed by immediate handwashing while another staff person, gloved, swabs down everything the patient touched.

Advantages, besides cheap, fast, and simple:  no physical contact between patient and staff is required in the ER.  Contact with other parts of the hospital is minimized--transport to an isolation area is controlled by a trained team, who will have with them, both protective garments and containment for any bodily fluids that emerge between the ER and isolation.  ER staff beyond the admitting office are not contaminated and will not need even brief isolation (allowing the ER to continue to function) and anyone in the ER when the possible Ebola patient arrives can be identified immediately for follow-up.

[User Picture]From: dr_phil_physics
2014-10-04 09:57 pm (UTC)
But, but.... how does your solution make millions for three different vendors? It's unworkable! And you have no M.D. after your name!

Ahem. Sorry. I had to remember to reboot my brain.

Dr. Phil
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[User Picture]From: e_moon60
2014-10-04 11:02 pm (UTC)
True. I am a lowly non-MD, and I'm not charging for the advice, so it must be worth what I'm charging, zilch.

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[User Picture]From: meirwen
2014-10-04 09:57 pm (UTC)


The very simplicity and sense of this proposal dooms it to automatic rejection by any administrator anywhere. *sigh*
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[User Picture]From: e_moon60
2014-10-04 11:54 pm (UTC)

Re: Alas

I suppose. And I suppose that's why no one ever considers me as an administrator (in which they are right, because I'm usually out designing a non-rectilinear box for something no one wanted to do in the first place.
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[User Picture]From: kengr
2014-10-05 01:13 am (UTC)
Your solution reminds me of my usual response way back when when asked for advice on buying a computer.

I'd ask what they wanted to use it for and nine times out of ten, after listening, I'd tell them to buy a card file box and some 3x5 cards. Because that'd be far better suited to their needs.

Heck, my primary storage for passwords is a couple boxes of 3x5 cards next to the computer. If they "crash" I just have to pick up the cards and re-sort them. :-)

I think I'd make one change to your suggestion. A third card to go in a file box there at admissions. Every so often, somebody would swap it for an empty box and make sure that ER and whoever else had actually gotten their cards and dealt with them properly.

I'n a firm believer in redundancy of critical info.
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[User Picture]From: dalesql
2014-10-05 02:46 am (UTC)
This is an obvious and simple solution, and I can't see any problems with it. Hospitals already have special protocols for all kinds of emergencies, so one more is not that huge a burden. At least for the better grade of hospitals that have the resources still allocated for things like staff education and other things that beancounter administrators don't see much need for.

ERs in busy urban areas, especially areas with high populations of illegal aliens, are already dealing on a regular basis with folks who have nasty infectious diseases. TB is the most common one seen, but all the others are still out there and pop up from time to time. So these ERs are already setup and probably have already added this flag to their travel history questions. ERs are mostly going to see Ebola patients that are already well into their infective period. Blood and body fluid precautions are also routine, so they really just need to step up the protocol levels until the epidemic in africa has passed.

The thing that is being overlooked is that Ebola initially presents as a non-specific viral illness. Headaches, body aches, mild fever, etc. Folks are not going to go to the ER for that, mostly. They are gonna self-medicate with over the counter stuff initally, then after a day or three, they get worse, and they go to their regular doctor, or to one of the new urgent care clinics or minute-clinics that are appearing on the scene for the minor emergencies that can't wait for an appointment with their regular doctor. These clinics are staffed with as few actual medical people as possible, since they are the expensive salaries. Usually just a single doctor, sometimes the doctor isn't even there, but only called in via videoconference when the nurse or PA see something unusual.

Poorer people, who don't have a regular doctor, or the money for a minute clinic, typically self-medicate with over the counter meds, or sometimes with their ethnic traditional medicine practitioner, I expect will wait until they are in some kind of medical crisis, then call EMS. And they are often overworked and underprotected for this kind of patient.

The only way we have right now to handle this is basic public health infection control. Identify the infectious patient. Obtain a contact history from the patient or their family/coworkers. Identify all the people who came into contact with the patient. Test and as needed, quarantine them, for the known incubation period. Obtain from the contact histories from all these contacts and give them training on what symptoms they need to watch for and what to do if they think they are sick. If any of the contacts get sick. They are a new patient and you repeat the process with them. and you keep on doing this with each and every patient who gets the disease until you have nailed it down, or your society collapses.

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[User Picture]From: seticat
2014-10-05 03:11 am (UTC)
It's times like this I miss the good old fashioned paper chart. Slap a bit red sticker on the front of the chart and folks notice it. Also, we used to use 'infection notification' cards that traveled with the patient and went at the head of their bed and on their room door. They were different color for different 'precaution' levels.

Sometimes the 'old way' works a lot better then the newer high tech.
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[User Picture]From: e_moon60
2014-10-05 11:06 pm (UTC)
Absolutely. Data in a computerized record is invisible until displayed or printed out, and then it often looks exactly like everything else. Even though we have color monitors and different font sizes...how often are these used in typical data processing applications?

Colored paper (in the form of stickers, cards, or colored marks on paper) stand out and are portable without having to load them onto another device.
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[User Picture]From: e_moon60
2014-10-06 04:44 pm (UTC)
If people think to use them. Note cards in THIS house--especially light blue and green ones--tend to go missing. Orange and yellow stand out, but soft green and blue are sort of dust-colored, and the carpet is gray. And as a person who is not a born organizer, I can have 100 note cards, each with 3 or more very important notes on it (the password for that, the phone number of someone, the time of medical appointment but not the day, the date of the medical appointment, but not the time, the deadline for an article, etc.)

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[User Picture]From: kkatowll
2014-10-06 08:57 pm (UTC)
The strange thing is that this is basically done for many other things. For example, nurses post signs on the door, in the room, and on the chart when someone is considered a falling risk.

Similarly, every time I've been to an ER during flu season, they've had a pile of masks and that rubbing-soap stuff with instructions to wear the mask if they have any of the following symptoms, followed by a list.

You'd think something similar could be done without any major shakeups in the medical system at any given hospital.

Of course, one could also argue that every city should designate one hospital as the one best equipped to handle Ebola, and post on the door of every other hospital that people who have traveled from (list of countries) in the past 21 days all go there.

Making matters trickier will be if it gets out of control here - then we can't rely on the red flag of travel.
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[User Picture]From: trebor1415
2014-10-08 04:44 am (UTC)
As a former long time ER and admitting clerk I can't see any reason this wouldn't work, other than staff error.

Mind if I share it with people who might be in a position to implement this at a couple institutions?
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[User Picture]From: e_moon60
2014-10-08 05:59 pm (UTC)
Please do. I'd be delighted if it eased confusion in a way that might help patients.
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