Hospital with Ebola patient lags peers in ER care

Posted at 12:22 PM, Oct 03, 2014

Texas Health Presbyterian Hospital -- under fire for releasing a Liberian man who later turned out to have the Ebola virus -- has lagged behind its peers on emergency room care and lost some federal funds the past three years because it had high discharge rates of patients who later had to return for treatment.

The hospital scored significantly worse than the state and national averages in five of six emergency care indicators, with emergency room wait times twice as long as the averages, according to data from the U.S. Centers for Medicare & Medicaid Services.

The hospital also was the most penalized in Dallas under a three-year program designed to reduce the number of patients readmitted for care, according to the data.

The delays in patient treatment in the emergency room, in particular, raise important questions about Presbyterian's emergency care, said Dr. Ashish Jha, a professor at Harvard University's School of Public Health and a practicing general internist.

He said Presbyterian could have too many patients for an understaffed emergency department or an inefficient system for handling the patients -- or both.

"It's probably a context in which you could imagine that errors would go up," Jha said, "and something important could get dropped."

Officials with Texas Health Resources, the parent company of Texas Health Presbyterian Hospital, said the findings were unrelated to the handling of the Ebola case.

"That's absolutely not related at all," said Wendell Watson, a spokesman for Texas Health Resources, the hospital's parent company. "We don't have any staffing issues in our (emergency room.) It's a very busy place."

Other large Dallas-Fort Worth hospitals also frequently performed poorly against the state and national averages on emergency room measures. Presbyterian, when compared with them, usually rated in the middle of the pack. The region's Level 1 trauma centers --Parkland Memorial Hospital, Baylor University Medical Center and John Peter Smith Hospital -- typically fared the worst.

But for Presbyterian, the data add to an already heightened scrutiny over the Ebola case. The hospital said late Thursday that a flaw with the electronic records system kept Thomas Eric Duncan's travel history from being communicated to physicians. He was released from the ER despite his having a fever and abdominal pain and telling a nurse that he had been in West Africa, where the Ebola virus was spreading. Under Centers for Disease Control and Prevention guidelines issued in August, that should have led the hospital to consider isolating Duncan and testing him for the virus.

Presbyterian Hospital officials have said Duncan did not appear to have early symptoms of Ebola at the time. But they acknowledge that his travel history was not conveyed to all members of the medical team. Officials said Thursday that the flaw with the electronic records system has been corrected so that travel history would automatically appear in a physician's workflow.

When he returned three days later by ambulance, his condition had worsened and he tested positive for Ebola. He remains at Presbyterian in an isolation unit.

The publicity surrounding the case has prompted patients to cancel appointments and avoid visiting the hospital campus, interim president and chief operating officer James A. Berg acknowledged in an email Wednesday to the hospital's medical staff.

"We are hearing from many of you that patients are canceling appointments and expressing fear of coming to the Texas Health Dallas campus," he wrote in the message, a copy of which was obtained by The Dallas Morning News.

Berg included "talking points" for reassuring the public, including that Duncan is isolated far from other hospital operations. The email includes a fact sheet about Ebola and steps that Texas Health Presbyterian has taken to bolster safety.

"We are working closely with the Centers for Disease Control and Prevention and following every suggested precaution to protect the health care workers who come in contact with the patient, as well as patients and visitors to the hospital," the email states.

Watson said the message was sent to help tamp down rumors. He said any patient cancellations or decline in emergency room patients were "nothing significant."

"We communicate very regularly with our employees," he said. "We like to make sure our employees are as well-informed as we can make it."

Texas Health Resources operates 25 hospitals in North Texas and 61 outpatient, surgery centers and other facilities. The nonprofit network reported operating revenue of $3.8 billion in fiscal 2013, with $6.1 billion in assets.
The emergency room data, which is shared by the federal Medicare/Medicaid agency through its Hospital Quality Initiative, was created to try to improve hospital care and better inform patients by distributing data on a range of clinical areas.

In the most recent time period available, October 2012 through September 2013, Presbyterian patients waited 52 minutes to be seen by a health care professional. They spent roughly an hour longer waiting to be sent home than patients at other hospitals.

The federal readmissions data does not evaluate the handling of patients in the emergency room. It measures how often patients must return after initially being hospitalized with heart attack, heart failure or pneumonia.

The penalties are based on the rate at which patients are readmitted within 30 days of discharge. Under the program, the hospital lost portions of its Medicare reimbursements in fiscal 2013 for exceeding the government's predicted rate of readmission.

The hospital lost 0.48 percent of its reimbursements in fiscal 2013, out of a possible 1 percent penalty. It lost .37 percent in fiscal 2014 out of a possible 2 percent penalty. For the upcoming fiscal 2015, Presbyterian will lose .10 percent out of a possible 3 percent penalty.

Statewide, Texas Health Presbyterian's readmission penalty ranked in the top third of all hospitals the first two years. About 100 to 150 of the more than 300 Texas hospitals subject to the program were not penalized each year.

Staff writer Steve Thompson contributed to this report.