Emory Hospital Shares Lessons Learned On Ebola Care
Atlanta's Emory University Hospital got the first call at the end of July. An American doctor who'd been treating Ebola patients in Liberia was now terribly sick with the virus himself. In just 72 hours, Dr. Kent Brantly would be coming through Emory's doors. Then, almost immediately, the staff learned that a second Ebola patient was also on the way. Dr. Jay Varkey's first thought was, "What do we need today, in order to care for these patients tomorrow?"
In the three months since, Emory has treated four Ebola patients; all survived. Most recently, Dallas nurse Amber Vinson spent more than a week in a special treatment unit at Emory before being discharged in restored health and good spirits Tuesday.
"The general dogma in our industry in July was that if patients got so ill they required dialysis or ventilator support, there was no purpose in doing those interventions because they would invariably die," Dr. Bruce Ribner, who heads Emory's Ebola team, told reporters at a news conference Tuesday. Emory, he said, proved instead that aggressively treating the illness can be effective.
Emory's plan to treat patients who have diseases like Ebola actually began 12 years ago. That's when the Atlanta-based Centers for Disease Control and Prevention started working with the hospital to create a special isolation unit.
Since then, Varkey says, a core team of health workers has trained yearly and held practice drills every six months to stay sharp — ready for whatever infectious disease comes their way. Once, in 2005, the unit was used for a suspected SARS case that turned out to be negative.
But in July, with two Ebola patients on the way, it quickly became clear that Emory's specially trained team was too small, says Nancye Feistritzer, the hospital's chief of nursing.
Critical care nurses volunteered to help fill in the gaps but weren't part of the core group that had long practiced for this day. The expanded team had to quickly train — and not everybody made the cut.
Once all the team members were in place, they focused on supportive care of these patients — administering IV fluids and preventing infections.
"The true cure for Ebola virus is keeping the patient alive long enough to develop the antibodies that will cause them to get over the infection," Varkey says.
Emory learned lessons, big and small, from each case, he says.
For example, just increasing the amount of working space around patients sick with Ebola helped a lot, he says. So did "having a hand sanitizer dispenser available that wouldn't require us to actually touch it with a gloved hand."
In Emory's experience, nurses on the Ebola unit, who started out on eight-hour shifts, preferred 12-hour rotations instead. And caring for the emotional health of patients in isolation is as important as promoting physical well-being, the staff learned.
Team members worked hard to coordinate their efforts. From top administrators to waste management crews, to pharmacists and lab technicians — every department played a role.
"Every morning the team meets to discuss what worked well, what might be refined," Feistritzer says, looking for lessons that might be put into practice the next shift, or the next day.
The Emory team doesn't claim to have all the right answers, Varkey says. But what they do know, they're sharing.
"Our entire 84-page document, in terms of our protocols," he says, "is now available to any person who wants to access that on the Web."
Those protocols went live a week ago. So far, more than 11,300 people have registered to get access to them.
This story is part of a reporting partnership between NPR, WABE and Kaiser Health News.
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Transcript
RENEE MONTAGNE, HOST:
A Dallas nurse who contracted Ebola while treating a patient from Liberia was released yesterday from Emory University Hospital. Amber Vinson was treated at a special unit at the hospital in Atlanta, which has now successfully treated four Ebola patients. Jim Burress from member station WABE takes a look at what they've learned there.
JIM BURRESS, BYLINE: It was July 30 when Emory got the call. An American doctor treating Ebola Liberia was himself dying of the virus. In just 72 hours, Kent Brantly would be coming through Emory's doors. Dr. Jay Varkey immediately sprung into action.
JAY VARKEY: What do we need today in order to care for these patients tomorrow?
BURRESS: Varkey says planning actually began 12 years ago. That's when the Atlanta-based Centers for Disease Control and Prevention started working with Emory to build a special isolation unit. Since then a core team has trained yearly and held practice drills every six months to stay sharp, ready for whatever disease comes their way. But almost immediately, Emory learned it would care for a second patient. So its specially trained team was too small, says chief nursing officer Nancy Feistritzer.
NANCY FEISTRITZER: We also needed to expand that team because we ended up with two patients simultaneously.
BURRESS: Critical care nurses volunteered, but they weren't part of that core group who'd long practiced for this day. The expanded team had to train and quickly. With a team now in place, attention turned to treatment. Varkey says they focused on supportive care, the basics, like IV fluids and preventing infections.
VARKEY: The true cure for Ebola virus is keeping a patient alive enough for them to develop the antibodies that will cause them to actually get over the infection.
BURRESS: More aggressive treatment should be used if needed, too, says Dr. Bruce Ribner. He heads Emory's Ebola team and spoke at a press conference yesterday.
(SOUNDBITE OF PRESS CONFERENCE)
BRUCE RIBNER: The general dogma in our industry in July was that, if patients got so ill that they required dialysis or ventilator support, there was no purpose in doing those interventions because they would invariably die.
BURRESS: Emory has had universal success in curing its Ebola patients, and Varkey says they have learned other lessons.
VARKEY: Increasing space might be helpful. Having a hand-sanitizer dispenser available that wouldn't require us to actually touch it with a gloved hand, those are sort of some simple examples that we have tried to transition from patient to patient.
BURRESS: Nurses who'd been on eight-hour shifts preferred 12-hour rotations. The team also learned patients, grappling with both a scary illness and isolation, needed emotional support. And from top administration to waste management crews, pharmacists to technicians, every department played a role. Chief nursing officer Nancy Feistritzer says they always assessed what they did.
FEISTRITZER: We have tried to harvest any learnings in an organized way. So, for example, every morning this team meets to discuss what worked well, what might be refined and then we took those learnings and actually put them into operation.
BURRESS: Emory's team doesn't claim they have all the answers, but Varkey says what they do know, they're sharing.
VARKEY: Our entire 84-page document in terms of all our protocols are now available to any person who wants to access that on the web.
BURRESS: Those protocols went live a week ago. So far, more than 11,300 people have registered. For NPR News, I'm Jim Burress in Atlanta.
MONTAGNE: And that story is part of a reporting partnership with NPR, WABE and Kaiser Health News. It's NPR News. Transcript provided by NPR, Copyright NPR.
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