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Emergency Department Syndromic Surveillance (EDSS): A public health unit perspective

Emergency Department Syndromic Surveillance (EDSS): A public health unit perspective. alPHa Meeting Feb 1, 2007. Objectives. Emergency Department Syndromic Surveillance KFL&A data collection, analysis alerting and investigation examples of use Grey Bruce examples of use

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Emergency Department Syndromic Surveillance (EDSS): A public health unit perspective

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  1. Emergency Department Syndromic Surveillance (EDSS): A public health unit perspective alPHa Meeting Feb 1, 2007

  2. Objectives • Emergency Department Syndromic Surveillance • KFL&A • data collection, analysis • alerting and investigation • examples of use • Grey Bruce • examples of use • Live Demonstration

  3. 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

  4. What information are we collecting? • 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

  5. Data Analysis • Anomaly detection runs 4x daily • 4 years of historical data • GIS mapping – ArcIMS (5-digit PC)

  6. 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

  7. Using Real-time data to support public health decision-making and monitor the effectiveness of public health interventions Examples of use

  8. GI and Respiratory

  9. 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

  10. 1 December 31, 2005 - Alert circulated based on- increasing ED visits for respiratory syndrome- increasing FRI positive patients - rise in admissions with respiratory diagnosis 2 January 4, 2006 – First Positive Influenza 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

  11. Other Uses • Environmental (heat alerts) • Disaster Medicine • Detect new/emerging diseases • Sentinel/event surveillance

  12. 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

  13. Other Uses in Grey Bruce • BWA’s • OTC Sales • Migraines

  14. 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

  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

  16. Live Demonstration

  17. Contacts (KFL&A) Dr. Kieran Moore moorek1@kgh.kari.net moorekieran@hotmail.com Bronwen Edgar bedgar@healthunit.on.ca Contacts (Grey Bruce) Dr. Hazel Lynn hlynn@publichealthgreybruce.on.ca Alanna Leffley aleffley@publichealthgreybruce.on.ca THANKS!

  18. 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

  19. Telehealth – Call Volumes and Types • June 1, 2004 – June 30, 2006 • Over 2,000,000 calls • Over 1.7 million ‘Symptom’ Calls

  20. Telehealth Respiratory Calls (3 day MA)and Flu A and B isolates All Resp Flu A isolates Flu B isolates

  21. Telehealth Respiratory Calls (x 5)and ED Visits - Ontario Telehealth Resp Calls ED Resp Visits

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