As New York faces the fourth case of Ebola to be diagnosed on U.S. soil, the experiences of those who cared for the first three patients here in Texas have begun to take on new context and meaning.
Before Thomas Eric Duncan presented to the emergency department at Texas Health Presbyterian Hospital Dallas, no hospital in this country had diagnosed a case of Ebola. His tragic death and the subsequent diagnoses of two nurses who cared for him are powerful reminders that medical knowledge is constantly evolving.
The experience at Presbyterian uncovered weaknesses in diagnosing this rare disease in our country, and measures that the U.S. Centers for Disease Control and Prevention had hoped would be effective in protecting health care workers proved less than perfect. But the experience gained in handling this unprecedented situation has contributed mightily to the ability of health care providers nationwide to better detect and care for Ebola patients and protect their own safety.
As the courageous nurses, doctors and staff at Presbyterian cared for these three Ebola patients, the hospital worked with the CDC to continuously update guidelines for diagnosing and treating Ebola and improving protection of personnel. In the aftermath, the hospital has continued to reassess what it got wrong and what it got right in order to make changes in its procedures, and to share its lessons learned to thousands of hospitals and health care providers nationwide.
At recent briefings of hospital, physician and nursing groups, Presbyterian officials outlined a number of changes they have implemented based on flaws uncovered in the overarching health care system at the local, state and national levels.
This knowledge will help the entire health care community, not only with Ebola but with other deadly infectious diseases. Among their major changes:
•They created new triage procedures to quickly identify at-risk patients.
•They added a procedure to isolate high-risk patients within five minutes.
•They upgraded medical-record software to clearly highlight risks, in particular travel history.
•They added a final step for clearing patients.
•They increased emphasis on face-to-face communication.
Interestingly, we have come to realize the importance of face-to-face communication among caregivers and between caregivers and patients. Electronic records are an increasingly important tool, but they cannot replace the personal exchange of information as a way to be sure the most important information is communicated effectively. This is a crucial heads-up for the entire U.S. health care field.
It is also important to appreciate that Presbyterian has also shown what does work in the nation’s readiness and response system. For one, the virus is showing itself to be readily containable as a public health threat because it is transmissible only through contact with bodily fluids of symptomatic patients, especially those who are in the advanced stages of the illness.
Rapid contact identification and effective isolation methods have protected the public from disease spread. This should be very reassuring to the public.
These have been extremely trying times for the Dallas area and especially for the men and women of Presbyterian. They didn’t expect to be the first, but they have acted with selflessness, honor and professionalism in caring for those struck with the disease. They have served this community valiantly while withstanding intense scrutiny and criticism.
Presbyterian should be honored for its role, not blamed. It has served the people of Dallas as a highly respected medical facility for nearly half a century, and this experience only further demonstrates that. It has taken aggressive measures to show that it is a safe and secure place to work and to receive quality medical care. The Dallas County Medical Society is very proud of Presbyterian’s actions. I’m confident the people of Dallas are as well and will continue to support this valuable institution.
Todd A. Pollock, M.D., is president of the Dallas County Medical Society. Reach him through president@dallas-cms.org/.
