“There’s a Person Behind Ebola”

Ebola-EDNurses

Rush emergency department nurses Lauren Callahan (standing) and Jenna Pederson (seated)

Rush emergency department (ED) nurses Lauren Callahan, MSN, RN, and Jenna Pederson, MSN, RN, wanted to show compassion for a patient who arrived in the ED on Oct. 21 in the same way they usually would for any patient. But this time was different.

The nurses were dressed in protective equipment, including a face mask that only showed their eyes behind a plastic shield. They also had to keep contact with the patient to the minimum degree necessary to provide care. In fact, Pederson had to stay on one side of a strip of tape that divided an ER decontamination room, with Callahan and the patient on the other.

Only a few hours off a long plane flight, the patient had been brought to Rush for medical evaluation after a screening at O’Hare International Airport flagged the traveler as being at risk for Ebola, given that the patient reported certain symptoms and came from Liberia, which is one of the West African nations where Ebola originates.

Yet even as they took stringent precautions to protect themselves from infection with a disease that horrifies many, Callahan and Pederson were moved by the patient’s situation – alone, frightened and possibly seriously ill.

“It was very humanizing. You hear, ‘Ebola, Ebola, Ebola,’ but there’s a person behind Ebola,” Callahan says.

“Jenna and Lauren were a bit anxious at first, but when they looked into the patient’s eyes, their caring nature and professional skills took over,” says Dino Rumoro, DO, chairperson of the Rush Department of Emergency Medicine. “I was moved by their swift reaction and compassion for a person in need of help.”

While Rush’s infectious disease experts ultimately determined the patient did not have Ebola symptoms, it was a powerful and instructive experience for the two young nurses (both of whom are enrolled in Rush’s Doctor of Nursing Practice program). Here, Callahan and Pederson discuss the evening and how their training and compassion prevailed over fear. (For privacy reasons, the interview has been edited to omit references to the patient’s gender.)

Why were you the nurses chosen to receive the patient?

Callahan: Jenna and I have a hazmat (hazardous materials) background. We’re both part of the hazmat team at Rush. We’ve been in drills and PPE (personal protective equipment) training prior to this event. We’ve been in suits together that cover us from head to toe. We were very comfortable not only in the suits but communicating with each other as well. When we got the call and they said, ‘we need someone in the suit,’ I said, why not?

Was it difficult to get into the equipment?

Callahan: We were getting regular updates about the patient’s arrival time from EMS (Chicago’s Emergency Medical Services division), 45 minutes, 30 minutes, 15 minutes. We suited up around 15 minutes. With the help of everyone we were able to get suited up really fast to limit our time in the suits. It’s a team effort. There’s someone who’s dressing us, who’s checking us.

Pederson: Anna Candoleza (another ED nurse) was our spotter. She was there for every moment of doffing (removing the protective equipment), because you’re tired, you’re drained emotionally, you’re drained physically from wearing it.

What happened when the patient arrived?

Callahan: I met the patient in the ambulance bay with our EMS director, Dr. (Louis) Hondros. The patient was able to walk in to the decontamination room, was covered in a blanket, and then zipped inside an isolation bag. We asked about symptoms, presenting complaints, and then we waited for the infectious disease doctors to get involved.

Then we just chatted. We found out about the patient’s favorite food, kids, work, a friend in Chicago.

What was different about caring for this patient?

Callahan: The biggest thing was being reminded that there is a person behind Ebola. The patient was afraid of being judged walking through the hallway.

Pederson: The patient was saying, ‘I would never want anyone to be injured.’ This person wanted to find out if it was Ebola as much as we did, and was happy to see we were taking it seriously.

Callahan: It was a little bit hard, because we were trying to limit contact until we knew. The patient care, the actual care aspect, isn’t the hands-on that we were used to.

The patient was crying at one point. I knew where a hand was (inside the protective bag), and I put my hand there.

Jenna: Normally, if you had a patient who said the things that this person said, you would sit next to them and give them a tissue, take their hand. We couldn’t provide the personal touches that you would at the bedside. We only could provide comfort by talking.

How did you feel when the doctors said the symptoms didn’t indicate Ebola?

Callahan: I was relieved, for the patient, the patient’s family, the grandkids that we learned about, relieved for the MICU (medical intensive care unit) team, relieved for my co-workers, everybody.

Pederson: Still, we did everything we would have done if the patient had been high risk. We doffed (the protective equipment), and I preferred that. If we were going to start high risk, we’re going to finish high risk. It’s still good practice. Even if it’s 100 percent there’s no chance, we’re still going to doff the same way.

The training we had helped. They make you doff in a slow, methodical fashion. I took off Lauren’s equipment fully before I started, and I was roasting. I felt like I was in an oven. But it had to happen that way.

Were you scared during all of it?

Pederson: Before we started, you had all this built up anxiety. This is the first case, and everyone’s running around. Once I was in the room and fully dressed, I wasn’t scared. Here it is. It’s go time.

Callahan: It’s the same if you get a call if there’s a cardiac arrest.  You rely on your training and your instincts. That initial adrenaline, we all have it in the ER, and we like it.

One Smart Dummy: Patient Simulators Help Save Lives

sim labBob lay in his hospital bed, eyes wide open and looking at the ceiling, when his condition took a turn for the worse. After being monitored for chest pain and low blood pressure all day, he suddenly went into cardiac arrest. A care team rushed to his side, administering an electric shock that normalized his heart rhythm and brought him to a stable state.

A good outcome, to be sure. But just in case the doctors weren’t entirely satisfied with their performance, they can ask Bob to do it all over again. And again.

That’s the beauty of the new Rush Clinical Skills and Simulation Center, which uses sophisticated dummies like Bob to simulate real-world patient care for students and health care workers from Rush University Medical Center.

“Simulation is a safe place to make mistakes,” says Nathan Walsh, manager of the simulation center, which opens Sept. 8. “It’s where we practice unfamiliar techniques and new procedures, address our inefficiencies and learn from our errors, so that by the time a team treats your loved one, they know exactly how to get it right.”

The Rush Center for Clinical Skills and Simulation, with its first phase of construction complete, significantly increases the number of future doctors, nurses and other care givers who can be accommodated. It has three times more capacity than Rush’s old simulation laboratory.

The 7,000-square-foot center utilizes advanced technology to help create patient scenarios that vary from the flu to serious heart conditions. The event mimics what a health care worker would experience in real life. Continue reading

See the Eight Best Buildings in Health Care Design

Rush TowerWe already knew Rush’s Tower is a great building, but we still were a little awed by the company it’s now in: A group of eight stunning buildings that the American Institute of Architects (AIA) selected as the 2014 recipients of the annual AIA National Healthcare Design Awards.

These buildings represent “the best in healthcare design,” according to the AIA, which announced the awards at the end of July. “These projects exhibit conceptual strengths that solve aesthetic, civic, urban, and social concerns as well as the requisite functional and sustainability concerns of a hospital.” (Founded in 1857, the AIA is a Washington, D.C.-based professional association for architects and their partners.)

Even the swanky design magazine Architectural Digest was impressed. It featured the Tower and the other award winners in this awesome slideshow on its “Daily AD” blog.

The buildings “push the boundaries of design to create uplifting spaces that are sensitive to the needs of patients and their families. It’s no easy feat,” blogger Asad Syrkett proclaimed.

Of course, these honors are nothing new. Last year, the Tower received the top award in the health category at the 2013 World Architecture Festival. It also was included as a finalist in two other prestigious international architecture competitions –  the World Architecture News Award and the Council on Tall Buildings and Urban Habitat’s Best Tall Buildings Award. In 2012, the Tower was one of only 10 health care projects in the world listed in global consultancy KPMG’s showcase of the 100 most innovative and inspiring urban infrastructure projects from around the world.

We’re glad to see the Tower get so much attention. We’re also thrilled it’s ranked among such great buildings. Give them a look.

Ebola: Cause for Concern, But Not for Panic

Dino Rumoro, DO

The worst recorded outbreak of the virulent Ebola virus has killed more than 2000 people in West Africa and is believed to have infected about 4,000 people since it began in March.

So far, the outbreak has been confined to West Africa (primarily Guinea, Liberia and Sierra Leone) and two suspected cases in the U.S. (in Dallas and Washington, DC).

Dr. Dino Rumoro, head of the Rush Department of Emergency Medicine, sees little danger to the U.S. from Ebola. He explained why in the following interview.

Q: Are you worried about Ebola coming here?

Rumoro: There are a lot of diseases that cause us a lot of concern. In the ‘80s, when we saw the emergence of HIV and AIDS, that made us very nervous as well, and we learned how to deal with it. Our experience dealing with other infectious diseases makes us prepared for this disease. This is a disease that we know about in the scientific community, but it’s not native to the United States.

Q: How is Ebola spread?

Rumoro: The key thing to remember with Ebola is that it’s not an airborne virus, so we’re not worried about it being transmitted through the air. We’re worried about contact with bodily fluids like blood, vomit and diarrhea. If those fluids enter another person’s eyes, nose, or mouth, an infection could occur.

Q: Who’s at risk for Ebola?

Rumoro: Anyone who comes in direct contact with body fluids of an infected person is at risk. Health care workers are at higher risk, just because they’re getting in close contact with body fluids. A close family member who may be caring for a patient is at even higher risk than a health care worker, because they don’t have the personal protection we use. Family members, if they’re cleaning up the diarrhea or the blood, they think, ‘it’s part of my job,’ and may ignore the need to protect themselves.

While Ebola is a highly dangerous and infectious disease, we can control it by using blood and body fluid precautions. We want to protect ourselves from any types of secretion. All we really need to do it is wear a face mask with an eye shield, wear gloves, gowns, and boot covers, and we need to wash our hands frequently.

There’s reason to exercise caution, but with the proper equipment, if you follow the rules you’ll be safe. The problem they have in the third world countries is they don’t have the personal protective equipment we have.

Q: Ebola is fatal between 60 and 90 percent of the time. What can be done to treat it?

Rumoro: The standard of care is support. Meaning, you’re going to treat the symptoms. One of the end stages is cardiovascular collapse. The blood pressure drops, the patient starts going into cardiac arrest.

Ultimately though, the source of that collapse is the virus, there is no treatment for the virus. So it would be supportive care at this point. We would try to ease the discomfort, try to keep the blood pressure maintained. It appears that the people who die of Ebola virus don’t mount the same immunologic response as the ones who live through it. If you get them through some of those rough points, maybe you give them enough time for a reactive response and they can fight the virus off.

(This post was updated on Oct. 3, 2014)

Drug May Slow Memory Loss Caused by Alzheimer’s

20040120-01-011A new research study at Rush University Medical Center and Northwestern Medicine is testing whether a new investigational treatment can slow the memory loss caused by Alzheimer’s disease.

The study will include men and women ages 65 to 85 who have normal thinking and memory function but who may be at risk for developing Alzheimer’s disease (AD) memory loss sometime in the future.

The purpose of the research study, called the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s study (the “A4 study” for short), is to test whether a new investigational drug, called an amyloid antibody, can slow memory loss caused by Alzheimer’s disease.

Amyloid is a protein normally produced in the brain that can build up in older people, forming amyloid plaque deposits. Scientists believe this buildup of deposits may play a key role in the eventual development of Alzheimer’s disease-related memory loss and dementia. The overall goal of the A4 study is to test whether decreasing amyloid with antibody investigational drug can help slow the memory loss associated with amyloid buildup in some people.

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Rush Ranked in Seven Specialties by U.S. News

RushTowerCloudsRush University Medical Center once again has been named one of the nation’s top hospitals, according to the new issue of U.S. News & World Report. Rush is ranked in seven of 16 categories included in the magazine’s 2014 -15 “America’s Best Hospitals” issue, which became available online on July 15, and is one of the two top-ranked hospitals in Illinois overall.

Rush’s orthopedics program was ranked No. 6 nationwide, making it the highest ranked orthopedics program in Illinois. Rush’s other ranked programs were geriatrics (No. 17); neurology and neurosurgery (No. 17); nephrology (No. 31); urology (No. 43); cardiology and heart surgery (No. 46); and cancer (No. 48).

U.S. News also noted that the following Rush specialty services are “high-performing”: diabetes and endocrinology; ear, nose and throat; gastroenterology; gynecology; and pulmonary.

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Rush is Only Illinois Hospital to Achieve “Advanced” Status in “Most Wired” Survey

Tower_TechnologyRush University Medical Center has been named one of only 20, advanced “Most Wired” hospitals in the nation, according to the 16th annual survey conducted by Hospitals & Health Networks. 

Out of 680 participants, Rush was one of only 20 organizations who met the criteria to be considered for “Most Wired–Advanced Organizations.” To make the advanced list, an organization must show exceptional results in the Most Wired Survey and Benchmarking Study.

The survey focused on health care systems and hospitals throughout the nation using clinical information systems that improve and enhance patient care and the patient experience. The 2014 Most Wired survey is published in the July issue of the magazine.

“This recognition reflects Rush’s deep commitment to use information technology (IT) that engages our patients, maximizes quality, safety, and efficiency of care, and help connect Rush with our broader health care community,” said Dr. Shannon Sims, PhD, associate chief medical information officer at Rush University Medical Center.

Nearly 67 percent of Most Wired hospitals share critical patient information electronically with specialists and other care providers. Most Wired hospitals use information technology to reduce the likelihood of medical errors. For example, at Most Wired hospitals, 81 percent of medications are matched to the patient, nurse and order using bar code technology at the bedside.

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