Computer Failure Jams County-USC

A breakdown of a new laboratory computer system at the county’s main public hospital last week substantially delayed urgent blood-test results for critically ill patients, causing the emergency room to declare an “internal disaster” and turn away ambulances.

The system at Los Angeles County-USC Medical Center became overloaded shortly after it was started Tuesday, and the backlog was so severe by Wednesday morning that emergency room doctors told the county to stop sending ambulances there for several hours. That request was repeated early Thursday.

Although no deaths or serious injuries have been attributed to the breakdown, doctors said delayed results for tests needed to confirm such serious conditions as heart attacks and kidney failure required doctors to make treatment decisions based on educated guesses and experience.

“It’s almost like practicing Third World medicine,” said Dr. Amanda Garner, a second-year resident in the emergency room. “We rely so much on our computers and our fast-world technology that we were almost blinded.”

Hospital officials also acknowledged Monday that about 100 chemotherapy patients -- or about half of the hospital’s weekly caseload -- received their weekly treatment up to one day late because essential blood tests were not processed.

Doctors were forced to keep patients in-house for hours or days longer than needed because they couldn’t access lab tests that would show they were OK to go home.

“It just ground the system to a halt, and turnover of patients ground to a halt,” said Dr. Edward Newton, acting chairman of the emergency department at County-USC.

Hospital officials say the most severe problems subsided after Thursday.

“I don’t mean to minimize all the stress,” said Dr. David Altman, the hospital’s chief medical officer. “The fact is that, at least as of this morning, we’re not able to discern any specific cases where patents were harmed other than significant inconvenience.”

But lab technicians said Monday that they still were overwhelmed by test requests and angry doctors.

“It’s a mess,” said medical technician Larceda Simms. “I’m barely keeping my head above water.”

Last week, the massive blood-test backlog ratcheted up tensions between doctors and lab technicians, who were forced to run tests by hand and search frantically for missing results.

Simms said one doctor came down to the lab demanding to know about his patient’s blood work. Simms said she told him that there were hundreds of specimens to look through. “He said, ‘That doesn’t help me and that doesn’t help my patient.’ ”

The county Department of Health Services expects to spend $22.1 million to install the lab computer system, called Misys, at all five of the county’s acute-care hospitals. The system is already in place at Martin Luther King/Drew Medical Center, where implementation was less problematic.

Ironically, the new system is designed to minimize medical errors and streamline hospital operations, ultimately replacing paper slips signed by doctors with computerized orders. The system allows doctors to order tests and get results from terminals throughout the facility, and ultimately will link up all county hospitals.

Altman said the rollout came “after what we thought was a fair amount of planning.”

As soon as it was activated, however, the system became overloaded, and a technical glitch kept the computer with patient information from communicating with the machine that processed tests. Also, lab technicians were struggling to master the new system as it was locking up.

Urgent lab tests were delayed up to three hours, Altman said, and regular lab tests took even longer to process. Compounding matters, the hospital was overflowing Tuesday and Wednesday with 760 patients.

Other hospitals that have implemented computerized ordering systems have suffered similar troubles at the outset. Earlier this year, Cedars-Sinai Medical Center was forced to suspend implementation of its new computer system for doctors’ orders because of protests from its medical staff.

Emergency room physicians at other hospitals faulted County-USC for rolling out the new system without a backup plan.

“Words fail me,” said Dr. Brian Johnston, an emergency room physician at White Memorial Medical Center, which is down the street from County-USC. “Who does such a thing in such a way that there was no backup? You don’t run it in such a way that it puts patients’ lives at risk.”

But at County-USC, emergency room doctors said they treated medical conditions conservatively, assuming the worst. They said that physicians are trained to gauge a patient’s condition without lab results -- based on their symptoms, coloring, descriptions of pain and tests such as X-rays and MRI scans.

But “it’s like turning the clock back 100 years when you have to base your assessment on clinical findings, physical exam findings, rather than laboratory findings,” Newton said.

ER doctors were able to perform quick, albeit less detailed, tests in the emergency room for blood sugar, hemoglobin and pregnancy, he added.

Ken Kark, a Misys spokesman, said he was not aware of the breakdown at County-USC and was trying to find out what happened. But he said he had “never heard of this kind of problem” with the system.

Despite the problems, Altman said he and senior administrators did not authorize the emergency department’s declaration of an “internal disaster,” which is used in such cases as power losses and floods.

“That was their opinion,” he said. “It would have been appropriate if they sought the guidance of the people who were in charge of the hospital to make those decisions.”

The last time the hospital’s emergency room closed for an internal disaster was June 26 because of a bomb threat, according to the county’s Emergency Medical Services Agency. “That’s not something that we would ordinarily call except under the most extreme circumstances,” Altman said.

Once the kinks are worked out, doctors said, the new system has the promise to reduce paperwork and improve patient care.

“Once it’s up and running, it’s going to be very effective,” said Garner, the ER resident. “It was very frustrating for two days, but I’m hoping it will work fairly soon.”