Becker's Clinical Quality & Infection Control

22 PATIENT SAFETY & OUTCOMES The severe condition surfacing among some COVID-19 long-haulers By Erica Carbajal A little-known yet serious autonomic nervous system disorder is surfacing among an unknown number of COVID-19 long-haulers, or people who experience persistent or worsening symptoms long after the infection has cleared, Kaiser Health News reported June 1. The condition, postural orthostatic tachycardia syndrome, affects the blood flow, and can disrupt the ability to reg- ulate vital bodily functions, such as heart rate and blood pressure. Symptoms include lightheadedness when stand- ing, a rapid increase in heart rate and fatigue. There are no federally approved drugs for the conditions, though spe- cialists use a variety of medications to manage symptoms. Prior to the COVID-19 pandemic, there were an estimated 3 million people in the U.S. with the condition. With just 75 board-certified autonomic disorder physicians in the country, it was already difficult to find a specialist for POTS and chronic fatigue syndrome, which have overlapping symptoms, according to KHN. Due to the lack of such specialists, it's not uncommon for peo- ple with these conditions or symptoms to wait months to get an appointment for care or an official diagnosis — an issue that's likely been exacerbated with POTS emerging among post- COVID-19 patients. Currently, most physicians with expertise in POTS are seeing COVID-19 long-haulers with the condition, and most post- COVID-19 patients with CFS also have POTS, Peter Rowe, MD, a researcher who has specialized in autonomic nervous system disorders for 25 years, told KHN. Specialists and people with POTS are now hoping the National In- stitutes of Health's $1.5 billion research effort on post-COVID-19 conditions will lead to progress in physician awareness and treat- ment of POTS and other autonomic disorders. n Patient who died at Florida VA hospital received 'deficient,' 'mismanaged' care, federal report finds By Erica Carbajal A patient who died in the emergency room at the Malcom Randall Veterans Affairs Medical Center in Gainesville, Fla., was incorrectly triaged, according to a June 3 report from the VA Office of Inspector General. e patient, who received laparoscopic colon surgery at the facility in summer 2020, sought care at the emergency department 15 days aer the procedure. Between day 10 and day 15 post-surgery, the patient had several conversations with the facility's call center regarding abdominal distension and vomiting. On three occasions, the call center instructed the patient to seek emergency care, according to the report. e patient went to non-VA hospitals the first two times, returning to Malcom Ran- dall Veterans Affairs Medical Center on the third occasion. Upon arrival, a nurse and nurse practitioner triaged the patient as level three and returned the patient to the waiting room. "Just over an hour aer the patient arrived at the facility's emergency department, the patient fell forward and was noted to be unresponsive and cyanotic with agonal breathing," the report said. e patient was then admitted to intensive care and died later that day. e patient should have been triaged as level two, meaning they could not wait to be seen, the report said. "e OIG found the nurse and nurse practitioner failed to consider all reasonable causes of the patient's shortness of breath, communicate with the patient's surgeon, and assign an [emergency severity index] level 2 to the patient," the report said. e OIG could not determine whether "more expeditious care would have affected the patient's mortality." e OIG issued two recommendations to the facility director: ESI level two patients should not remain in the waiting room, and evaluations of additional quality reviews are needed based on the failures identified in the report. A spokesperson for the medical center told local CBS 4 News the OIG's recommendations were implemented as of May 28. "Any death that happens is tragic, and certainly we all feel for the patient and for the family," omas Wisnieski, facility director, said during a vir- tual town hall meeting June 4, according to e Gainesville Sun, adding that the nurses involved have since struggled with feelings of guilt. "We're not perfect by any means, but one of the things that happens within our system is that if there's something that goes wrong, we own it, and we look to fix it," Mr. Wisnieski said. Becker's reached out to Malcom Randall VAMC but did not receive a response at the time of publication. n "We're not perfect by any means, but one of the things that happens within our system is that if there's something that goes wrong, we own it, and we look to fix it." - Thomas Wisnieski, facility director, Malcom Randall Veterans Affairs Medical Center

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