Monday Musings

I heard on the radio recently that Presbyterian hospital in Dallas reached an undisclosed settlement with the family of the man who died of Ebola. His death might have been avoided if he had not been sent home from the ER the first time. According to news reports, the ER nurse working in her “nursing” record on that first visit to the hospital noted that the patient had recently traveled to Liberia where the Ebola outbreak was occurring. This was in the section of the chart where immunizations and travel were recorded, a part of the record segregated from the doctor’s documentation. The argument for this segregation is to allow the nurse to be able to document and sign-off her portion of the chart independently from the doctor in order to improve “work flow.” It was very efficient and very deadly.

In a hospital based outpatient wound center, there is no “nurse only” portion of the chart. Every observation that the nurse makes is a vital portion of the chart and contributes to the appropriate care of the patient. Having separate work flows for the physician and the nurse leads to segregation of care. It’s also legally problematic in the provider based setting where the physician is responsible for all the documentation and the care of the providers under his or her supervision. Segregating the nursing documentation in the wound center EHR is NOT a “feature,” it’s a liability.