When the patient arrived, he started twitching uncontrollably. The elderly gentleman had been brought by worried family members to see a specialist at the Kaiser Permanente Santa Clara Medical Center in California late last year. The doctor there thought the man might be having an epileptic seizure—only he soon stopped twitching and, a minute later, seemed fine. Unsure of what to do next, the outpatient doctor called James Lin, chief of the hospital’s emergency department. Should he send the man to neurology, as he would an epileptic patient, or to emergency?
Lin, a fast-talking 38-year-old with brush-cut hair and freckles, had his colleague wait while he looked up the patient’s records on the hospital’s electronic health record (EHR) system. In an instant, he saw that the man had a history of twitching episodes from which he recovered quickly; usually people suffering epileptic seizures tend to remain confused and disoriented afterward. “Send him over to me right away,” Lin said. Minutes later, Lin put the patient on a cardiac monitor and confirmed that the man’s brain wasn’t the source of his medical issues. He watched as the patient’s heart rate slowed. There was a long pause between beats, during which the man started twitching again. He was at risk of cardiac arrest. Lin transferred him to the intensive care unit, where he was outfitted with a pacemaker in a matter of hours. Lin says the man might have died if he had gone to the neurology clinic. The doctors there don’t have cardiac monitors and might not have diagnosed his condition in time.