Minnesota hospitals lock down details as they prepare for Ebola threat

Minnesota hospitals are in a heightened state of readiness following confirmation this week of the first U.S. case of Ebola in Texas.

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Hennepin County Medical Center already had a four-hour Ebola preparedness drill in the works before the Dallas case surfaced. HCMC says the drill showed that its staff is ready to properly handle any Ebola patients they might receive, though doctors and nurses did find a few things they want to tweak.

Most of the lessons learned during HCMC's preparedness drill were minor. A garbage can was too small to handle the extra protective gear that would be deposited in it; and a hospital laboratory didn't have enough counter space for all the testing that might be needed to rule out a suspected Ebola case.

But one key issue emerged: HCMC discovered a communication gap in its electronic medical record system.

Crucial questions that triage nurses ask patients about fever and about their travel history weren't showing up easily in electronic medical charts for all health providers to see, said Dr. John Hick, HCMC's medical director for emergency preparedness.

That could set in motion problems similar to the communication gaps that caused a Texas hospital to mistakenly send home a patient who had Ebola.

"It wasn't necessarily flagging on our electronic board," said Hick. "So we're working with Epic, our electronic health record, to create a flag for that patient so there's an alert on that patient when their chart is opened. That's something I think we've learned already from experiences that others are having."

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Triage nurses at HCMC are expected to pass along important travel details verbally to emergency room physicians and nurses if they suspect a patient has a highly infectious disease. If that discussion doesn't happen, it's important to be able to rely on the electronic health record as a backup, Hick said.

"Communications errors happen, and it's a matter of trying to make sure you drop the forks and not the china," he added.

Minnesota hospitals have done a lot of work on Ebola preparedness and could be held up as a model for the country, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

The center has heard from a number of Minnesota hospitals that have re-examined the way they communicate patient travel histories among staff, he said.

The Texas case has been a wake-up call for hospitals, said State Epidemiologist Dr. Ruth Lynfield.

"I think it is making people open their eyes wider and review and make sure that their policies and procedures are up to snuff, and that we can learn from what happened in Texas so that it wouldn't happen here," she said.

The Texas incident also demonstrates how important it is for patients to be open about their travel histories, she added. The Minnesota Department of Health has been encouraging hospitals to post more signs in their emergency departments and clinics reminding patients to disclose if they've traveled in the past 21 days.