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

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 Mooremoorek1@kgh.kari.net

moorekieran@hotmail.com

Bronwen Edgarbedgar@healthunit.on.ca

Contacts (Grey Bruce)

Dr. Hazel Lynnhlynn@publichealthgreybruce.on.ca

Alanna Leffleyaleffley@publichealthgreybruce.on.ca

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

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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