emergency department syndromic surveillance (edss): a public health unit perspective alpha meeting...
TRANSCRIPT
Emergency Department Syndromic Surveillance (EDSS): A public health unit perspective
alPHa MeetingFeb 1, 2007
Emergency Department Syndromic Surveillance KFL&A
– data collection, analysis– alerting and investigation– examples of use
Grey Bruce– examples of use
Live Demonstration
Objectives
Ontario Pilot Project
MOHLTC PHD funded – partners include: KFL&A Public Health, Queen’s University, PHAC, local acute care hospitals
2 year pilot project Sept/04-Aug/06– Implement and evaluate EDSS system
Primary goal – Respiratory, GI ‘Live’ alert investigation Aug/05-present Evaluations – comprehensive 3 parts
Real-time - ED visits to 7 area hospitals (KFL&A and HPE Health Units), admissions to 3 hospitals
Date and Time of Visit or Admission Hospital Age/Sex Postal Code (5 digits) Chief Complaint Triage Score Febrile Respiratory Illness (FRI) Screening results
Syndromes: Gastroenteritis, Respiratory, Fever/ILI, Asthma, Derm-infectious, Neuro-infectious, Severe Infection, Other
What information are we collecting?
Data Analysis
Anomaly detection runs 4x daily 4 years of historical data GIS mapping – ArcIMS (5-digit PC)
Alerts and Investigation
Automatic email notification of alerts System is monitored 7 days a week As per protocol – notify CD/EH staff of
anomalies, admissions of interest Resource for CD/EH outbreak investigation Bi-weekly reports to ED, ICP, Lab, public health Approx. 10% of alerts passed on
Using Real-time data to support public health decision-making and
monitor the effectiveness of public health interventions
Examples of use
GI and Respiratory
Retrospective Analysis - EARS graph of revised GI syndrome (diarrhea +/- other Sx) for patients visiting KGH and HDH ED - Nov/05
Initial cluster of patients presents to ED with diarrhea +/- other symptoms –
cultures taken
0
10
20
30
40
50
60
9/1/2005 10/1/2005 11/1/2005 12/1/2005 1/1/2006 2/1/2006 3/1/2006 4/1/2006
FRI +
Fever/ILI
Resp
0
1
2
3
4
5
9/1/2005 10/1/2005 11/1/2005 12/1/2005 1/1/2006 2/1/2006 3/1/2006 4/1/2006
Resp - CuSUM
Resp - RLS
Fever/ILI - CuSUM
Fever/ILI - RLS
0
1
2
3
4
5
6
9/1/2005 10/1/2005 11/1/2005 12/1/2005 1/1/2006 2/1/2006 3/1/2006 4/1/2006
Positive Influenza
0
1
2
3
4
5
6
9/1/2005 10/1/2005 11/1/2005 12/1/2005 1/1/2006 2/1/2006 3/1/2006 4/1/2006
Resp Admissions
Fig.2 – Prospective Monitoring 2005/06 flu season
System Alerts
ED visits by Syndrome
Positive Influenza Laboratory Results
Respiratory Admissions September 2005 to April 2006
January 4, 2006 – First Positive Influenza
2
December 31, 2005 - Alert circulated based on- increasing ED visits for respiratory syndrome- increasing FRI positive patients - rise in admissions with respiratory diagnosis
1
Other Uses
Environmental (heat alerts) Disaster Medicine Detect new/emerging diseases Sentinel/event surveillance
Grey Bruce ECADS System (NRC)
12 hospitals 400-500 daily ED visits
Area covered: Grey and Bruce Counties (8664 sq km) Population 153,000 plus higher during
summer season
Other Uses in Grey Bruce
BWA’sOTC SalesMigraines
Cryptosporidium in Grey Bruce
Average number of cases per year is 13 (range 7 to 19)
Crude incidence rates more than double the provincial average
Local cases usually associated with direct exposure to livestock manure or swallowing recreational water
One outbreak in region in 1998 associated with Collingwood municipal water system
GBHU Cryptosporidiosis Cases 2006
0
1
2
3
4
1 5 9 13 17 21 25 29 33 37 41 45 49
Week
# of
Cas
es
GBHU Cryptosporidiosis Cases 2006 by Week
0
1
2
3
4
5
19 21 23 25 27 29 31 33 35 37 39 41
Week in 2006
# of C
ases
OTC Jun 4
ECADS GI Alert J 14 to 17
GBHU Alert to EDs re-GI increase - do stool tests J 16
OTC Aug 2-12
OTC Aug 20-Sept 9
GBHU notifies area HUs & MOHLTC of increase
CIOS Alert posted
OTC May 27
ECADS GI Alert May 14 & 15
Conclusions
Now have a clearer picture of what is going on in the community
System is easy to install, monitor, access, maintain
Did not require changes to existing staff, procedures
Most ED staff were not aware that the system was in place
Opportunity for Public Health and Grey Bruce hospitals to work together, share information
Live Demonstration
THANKS!
Contacts (KFL&A)
Dr. Kieran [email protected]
Bronwen [email protected]
Contacts (Grey Bruce)
Dr. Hazel [email protected]
Alanna [email protected]
Ontario’s Telehealth System Data Elements and Timelines
Timelines– June 1, 2004 until June 30, 2006
Data Elements– Date and Time of Call– Patient’s Age and Sex– Forward Sortation Area of patient’s residence– Call Type– Guideline– Recommended Disposition
Telehealth – Call Volumes and Types
June 1, 2004 – June 30, 2006
– Over 2,000,000 calls– Over 1.7 million
‘Symptom’ Calls
Call Type # of Calls
Health Information
231,453
Service Referral
99,653
Symptom 1,711,344
All Calls 2,042,450
0
100
200
300
400
500
600
700
800
6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006
Telehealth Respiratory Calls (3 day MA) and Flu A and B isolates
All Resp
Flu B isolates
Flu A isolates
0
500
1000
1500
2000
2500
3000
3500
4000
6/1/2004 8/1/2004 10/1/2004 12/1/2004 2/1/2005 4/1/2005 6/1/2005 8/1/2005 10/1/2005 12/1/2005 2/1/2006 4/1/2006 6/1/2006
Telehealth Respiratory Calls (x 5)and ED Visits - Ontario
ED Resp Visits
Telehealth Resp Calls