I learned long ago that mistakes are most often made when we deviate from the plan. Sometimes we deviate because we don’t think it is important to stick to the plan, or that we can do something better than the plan someone else has laid out for us. At other times, we deviate because we have become so familiar with what we are doing, we don’t pay strict enough attention, or we fail to think carefully about the steps we should be taking. Sometimes, we don’t follow the plan because we are too tired, or we are trying to handle too much.
In certain situations, plans are critically important because it’s necessary that everyone carry out a certain set of actions in the same way. In these cases, variation can cause harm. My role, and the role of the Health System Executive Team, is to provide those plans to you as they become available. Your role is to follow the plan exactly—every patient, every encounter, every time. Thus, your role is vital to everyone’s success.
When someone on the team does not follow the plan, that individual essentially becomes the weak link; and by the same token, I become the weak link if I fail to give you the most current information and plans we have. In the case of the spread of Ebola, we don’t have all of the answers yet. However, we are sharing information and our plans through various communication vehicles, such as the Friday Flash Report, today’s Town Hall meeting, and other methods, as soon as we have them. Our top priority is to always assure that our patients and staff are safe and that our patients always receive the best care.
Because of employee concerns about Ebola, our team of executives, senior leaders, directors and managers have been rounding and meeting with many people this week to help you understand the plan that is developed to-date, as well as to hear your questions and concerns. This activity will continue until we are comfortable that each person knows what they are to do regarding screening and isolation of any patient who presents with symptoms of Ebola, has traveled to a CDC-identified country with widespread Ebola transmission, or has come into contact with a patient diagnosed with Ebola and the 21-day incubation period is not over.
Currently, the greatest concern we have heard from our employees is that not everyone in the clinical settings has been trained: “Will I have to care for someone if I am not trained?” The answer is no. A select number of individuals been identified, volunteered, and have been specially trained to care for such a patient. A decision has also been made to limit the number of people who would treat a patient, if we receive one, who is diagnosed with Ebola. The rest of our staff will continue to do the good work that they do for our other patients, will be trained to screen for the virus, and to support those who are on the front lines of providing care.
For all points of entry for our patients, whether it is by phone, as they arrive in a clinic or ambulatory setting, or come to our Emergency Department, the people who first encounter the patients must screen each and every patient with the screening tool that is now available in Epic (the tool will be activated once a patient’s chart is opened). For areas not currently on Epic, the same screening protocol applies, only they will conduct the process by paper. This protocol includes asking a series of “symptom” questions, and if the patient’s symptoms are consistent with Ebola, we will then ask a question related to their travel history and/or their potential exposure to anyone diagnosed with Ebola. If the answer to the second question is “yes”, we will strictly adhere to the following steps, without deviation:
- We isolate the patient.
- We put on our personal protective equipment (PPE).
- We immediately call Healthcare Epidemiology at 409-772-3192 (department) or 409-643-3133 (24/7 pager).
A detailed policy regarding patient calls has been distributed by Ambulatory Operations, and it will be reviewed with staff.
If you encounter a patient who has not yet been screened, please do so. If a patient asks why we are doing this every time they call or every time we see them, please politely explain to them that it is important for their safety, the safety of other patients, and the safety of our staff.
If a decision is made to transfer an infected patient to the UTMB-Galveston Emergency Department by ambulance, we have the necessary plans in place, as we have collaborated with Galveston EMS and Windsor Ambulance services—the two EMS agencies that serve the UTMB Health Galveston Campus and the UTMB Health Angleton Danbury Campus most often. We are currently in the process of identifying and working with other ambulance providers for our Regional Maternal Child Care Program (RMCHP) clinics. And, Correctional Managed Care (CMC) is working collaboratively with the Texas Department of Criminal Justice to finalize their plans.
I know that many people are anxious about Ebola in Texas and elsewhere. But please rest assured that our world-renowned infectious disease experts at UTMB have been working with this virus for ten years without any infections. We are home to the Galveston National Laboratory, the highest level biocontainment facility, which also serves as the nation’s training site for Biocontainment Safety. We have more expertise and experience with this disease than most, if not all, academic medical centers in Texas.
We are all very concerned about the people affected by this disease. However, let’s make sure that we maintain our calm and steady leadership through this time, and take comfort in the fact that working together, we are more prepared than most organizations to manage this disease.
I know many of you have questions, and even if you are not included in the care of the patient, you want to know the answers. We are currently collecting inquiries and working with individuals in the institution to gather the responses to your questions and concerns, which will be posted on our intranet once they are prepared. Please share your questions with us. You may contact us at email@example.com or using the Health System Q&A form.