On The Alert For Ebola, Texas Hospital Still Missed First Case

On The Alert For Ebola, Texas Hospital Still Missed First Case

8:57am Oct 02, 2014
Traffic moves past Texas Health Presbyterian Hospital in Dallas, where a patient showed up with symptoms that were later confirmed to be Ebola.
Traffic moves past Texas Health Presbyterian Hospital in Dallas, where a patient showed up with symptoms that were later confirmed to be Ebola.
Mike Stone / Getty Images

Hospitals have been on the lookout for the Ebola virus in the United States, and Texas Health Presbyterian in Dallas was no exception. A nurse there did ask about the travel history of the patient who later turned out to be infected with the virus. But some members of the medical team didn't hear that the man had recently been in West Africa. So he was initially sent home — even though he was experiencing symptoms of Ebola, and that meant he was contagious.

"As a result," says Mark Lester of Texas Health Resources, the hospital's parent company, "the full import of that information wasn't factored into the clinical decision-making."

When the man returned two days later, by ambulance, hospital staffers finally realized what they might be dealing with.

The patient is now in isolation and being treated, while public health workers are tracking and monitoring anyone who had close contact with him.

Edward Goodman, hospital epidemiologist at Texas Health Presbyterian, said government officials have recently been bombarding hospitals with information on how to properly screen and isolate patients.

Just last week, in fact, a team at his hospital had a meeting to go over a special checklist sent out by the Centers for Disease Control and Prevention.

"We were prepared," Goodman said.

Despite that preparation, they missed it.

This case shows the challenge hospitals face because the initial symptoms of Ebola — such as fever and headache — are the same as other illnesses.

Still, infectious disease specialists say diagnosing and treating Ebola isn't really that difficult — every hospital in the U.S. should be able to do it.

Hospitals around the nation have been getting ready. "We're going to be seeing more cases in the U. S., particularly travel-related," says Gabor Kelen, director of the office of critical event preparedness and response for Johns Hopkins in Baltimore.

The university's hospital system has been training workers how to safely care for suspected Ebola patients, and has been holding town-hall-style meetings to raise awareness.

Some hospitals have recently started asking every patient who shows up at the emergency room about recent travel, regardless of symptoms.

"We don't want to miss any single case," says Ross Wilson, chief medical officer at New York City Health and Hospitals Corp. The company's 11 emergency departments get more than 1.2 million visits a year. And for the past few weeks, because of Ebola, Wilson says, every single person has been asked about travel.

"If they have a positive travel history and any symptoms that could be close, that immediately activates isolation before any further workup occurs," Wilson says.

Every week, his hospital system sees about seven patients who have both recently been in West Africa and have worrisome symptoms. So far, they've turned out to have other illnesses — like malaria.

To keep staffers on their toes, Wilson says, his hospitals have been getting surprise practice drills, with people trained to walk in and pretend to have possible signs of Ebola. "This has been a very helpful way for us to assess, but also to learn from," says Wilson. He says such simulations can show "where things aren't working as well as we thought they might be."

That's important because, as Texas found out, the next person who comes in might have Ebola for real.

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Transcript

AUDIE CORNISH, HOST:

It was really only by chance that Dallas was the first American city to see someone show up in an emergency room with Ebola. Hospitals across the nation have been preparing for this possibility for weeks. The goal has been to quickly identify and isolate anyone who might have Ebola. NPR's Nell Greenfieldboyce reports on why the hospital in Texas didn't suspect Ebola right away.

NELL GREENFIELDBOYCE, BYLINE: A person sick with Ebola who goes to an emergency room isn't supposed to be sent home, but that's what happened the first time a man visiting from Liberia went to Texas Health Presbyterian Hospital in Dallas. Here's what Edward Goodman, the hospital's epidemiologist, said earlier this week at a press briefing.

(SOUNDBITE OF PRESS BRIEFING)

EDWARD GOODMAN: I think he was evaluated for his illness, which was very nondescript. He had some laboratory tests, which were not very impressive. And he was dismissed on some antibiotic because he was like the majority of people who come in the emergency room.

GREENFIELDBOYCE: Why didn't anyone ask about recent travel to places like West Africa? Well, it turns out someone did. Yesterday, more information came from Mark Lester of Texas Health Resources, which runs the hospital. He said a nurse followed a checklist and did ask.

MARK LESTER: That nurse was part of a care team; and it was a complex care team taking care of him in the emergency department. Regretfully, that information was not fully communicated throughout the full team. And as a result, the full import of that information wasn't factored in to the clinical decision-making.

GREENFIELDBOYCE: And so the hospital let a patient with Ebola who was contagious walk out the door. Two days later, when he returned by ambulance, they realized he'd been in Liberia and understood what they might be dealing with. Hospitals have known for weeks, if not months, that they need to be on the lookout for Ebola. Goodman at Texas Health Presbyterian said government health officials have been bombarding hospitals with information on how to properly screen and isolate patients. Just last week, a team at his hospital had a meeting to go over a special checklist sent out by the Centers for Disease Control and Prevention.

GOODMAN: We were prepared.

GREENFIELDBOYCE: Despite that preparation, they missed it. This case shows the challenge hospitals face because the initial symptoms of Ebola - fever, headache - are the same as other illnesses. Still, experts say diagnosing and treating Ebola isn't really that difficult; every hospital in the U.S. should be able to do it. Gabe Kelen is director of Critical Event Preparedness and Response for Johns Hopkins in Baltimore. Its hospital system, like many others, has been doing training to teach workers about how to safely care for suspected Ebola patients. And it's been holding town hall meetings to raise awareness.

GABE KELEN: We're going to be seeing more cases in the U.S., particularly travel-related.

GREENFIELDBOYCE: Some hospitals have recently started asking everyone who shows up at the emergency room about recent travel, regardless of symptoms.

ROSS WILSON: We think we are fulfilling all of the guidance from the CDC. We think we're probably making sure we do it as well as we possibly can. We don't want to miss any single case.

GREENFIELDBOYCE: Ross Wilson is chief medical officer at New York City Health and Hospitals Corporation. Its 11 emergency departments get more than 1.2 million visits a year. Wilson says for the last few weeks, because of Ebola, every single patient is asked about travel.

WILSON: And if they have a positive travel history and any symptoms that could be close, that immediately activates isolation before any further work-up occurs.

GREENFIELDBOYCE: He says every week they see about seven patients who've both recently been in West Africa and have worrisome symptoms. So far, they've turned out to have things like malaria. To keep hospital staffers on their toes, his system has been running surprise practice drills. They've had people walk in and pretend to have possible signs of Ebola.

WILSON: And this has been a very helpful way for both for us to assess but also to learn from where things aren't working as well as we thought they might be.

GREENFIELDBOYCE: That's key, because as Texas found out, the next person who walks in might have Ebola for real. Nell Greenfieldboyce, NPR News. Transcript provided by NPR, Copyright NPR.

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