Emergency Department (ED)

Like many other states in the U.S., Missouri has experienced large increases in opioid abuse resulting in hundreds dying each year and thousands of ED visits due to overdose. Missouri has two major urban areas, St. Louis and Kansas City and a few smaller cities, while the remainder of the state is more rural in nature. The opioid epidemic has impacted all areas in the state but the magnitude of that impact varies as well as the type of opioid used. Missouri Department of Health and Senior Services (MODHSS) maintains the Patient Abstract System (PAS) which contains data from hospitals and ambulatory surgical centers throughout the state. PAS includes data from ED visits including information on diagnoses, patient demographics, and other information about the visit. MODHSS also participates in the Enhanced State Surveillance of Opioid-involved Morbidity and Mortality project (ESOOS). One major aspect of this surveillance project is the collection of data on non-fatal opioid overdoses from ED visits. Through this collection of data, MODHSS analyzed opioid overdose visits throughout the state, how rates compare across urban and rural areas, and how those rates have changed over time.

Objective:

Compare rate changes over time for Emergency Department (ED) visits due to opioid overdose in urban versus rural areas of the state of Missouri.

Syndromic Surveillance (SS), traditionally applied to infectious diseases, is more recently being adapted to chronic disease prevention. Its usefulness rests on the large number of diverse individuals visiting emergency rooms with the possibility of real-time monitoring of acute health effects, including effects from environmental events and its potential ability to examine more long-term health effects and trends of chronic diseases on a local level.

Objective:

To create chronic disease categories for emergency department (ED) chief complaint data and evaluate the categories for validity against ED data with discharge diagnoses and hospital discharge data.

Since 2008, drug overdose deaths exceeded the number of motor vehicle traffic-related deaths in Indiana and the gap continues to widen1. As the opioid crisis rages on in the United States the federal government is providing funding opportunities to states, but it often takes years for best practices to be developed, shared, and published. Indiana State Department of Health (ISDH) has developed a standard process for monitoring and alerting local health partners of increases in drug overdoses captured in Indiana’s syndromic surveillance system (ESSENCE). ISDH is launching a pilot project to encourage local partners to start a conversation about overdose response capabilities and planning efforts in their community. Other states have published articles about drug overdose syndromic surveillance (SyS) data being used to inform local public health action, however, the local overdose response activity details were vague 2,3. With the opioid crisis continuing to spiral out of control in the United States, it is imperative to work together as local, state, and national partners to find potential solutions to this crisis.

Objective:

The overall objective of this session is to discuss opportunities to use drug overdose syndromic surveillance (SyS) data to encourage action among local public health partners. After this roundtable discussion, participants will be able to:

• Identify opportunities to promote use of drug overdose SyS data to their health partners.
• Plan for potential drug overdose public health interventions.
• Develop relationships with roundtable attendees to continue the conversation and sharing of ideas about use of drug overdose SyS data.

Pneumonia, an infection of the lung due to bacterial, viral or fungal pathogens, is a significant cause of morbidity and mortality worldwide. In the past few decades, the threat of emerging pathogens presenting as pneumonia, such as Severe Acute Respiratory Syndrome, avian influenza A(H5N1) and A(H7N9), and Middle East Respiratory Syndrome coronavirus has emphasised the importance of the surveillance of pneumonia and other severe respiratory infections. An unexpected increase in the number of hospital admissions for pneumonia or severe respiratory infections could be a signal of a change in the virulence of the influenza viruses or other respiratory pathogens circulating in the community, or an alert of an emerging pathogen which warrants further public health investigation. The purpose of this study was to develop a forecasting model to prospectively forecast the number of emergency department (ED) admissions due to pneumonia in Singapore, a tropical country. We hypothesise that there is complementary information between hospital-based and community-based surveillance systems. The clinical spectrum of many respiratory pathogens causing pneumonia ranges from asymptomatic or subclinical infection to severe or fatal pneumonia, and it is usually difficult to distinguish between the different pathogens in the absence of a laboratory test. Infected persons could present with varying degrees of severity of the infection, and seek treatment at different healthcare facilities. Hospital-based surveillance captures the more severe manifestation of the infection while community-based surveillance captures the less severe manifestation of the infection and enables earlier detection of the infection. Thus, the integration of information from the two surveillance systems should improve the prospective forecasting of ED admissions due to pneumonia. We also investigate if the inclusion of influenza data from the laboratory surveillance system would improve the forecasting model, since influenza circulates all-year round in Singapore and is a common aetiology for pneumonia.

Objective:

To develop a forecasting model for weekly emergency department admissions due to pneumonia using information from hospital-based, community-based and laboratory-based surveillance systems.

Syndromic surveillance has been widely implemented for the collection of Emergency Department (ED) data. EDs may be the only option for seeking care in underserved areas, but they do not represent population-based measures. This analysis provides insight on health-seeking behaviors within the context of the type of care sought.

Objective:

To analyze differences in utilization of Emergency Departments for primary care sensitive conditions by facility and by patient ZIP code.

In May 2015, the MERS-CoV outbreaks in South Korea was sparkled from a hospital of Gyeonggi-do province. In response to this outbreak, the provincial government and infectious disease control center (GIDCC) initiated an emergency department (ED) based Gyeonggi-do provincial acute febrile illness (AFI) surveillance network (GAFINet) to monitor for a subsequent outbreak of emerging or imported infectious diseases since September 2016. Gyeonggi-do province is located in the North-West of South Korea, surrounds the capital city Seoul, and borders North Korea (Figure 1). Considering the geographical coverage, GAFINet Initiative involves ten hospitals, consisted of four university-affiliated hospitals and six provincial medical centers in Gyeonggi-do province. These hospitals participated in this network voluntarily, and most staffs including five infectious diseases specialists had direct or indirect experiences in dealing with MERS-CoV patients.

Objective:

The objectives are to introduce a provincial level surveillance system, which has been initiated in response to the MERS-CoV outbreak of South Korea, and describe findings from systematic investigation of individual admissions attributed to acute febrile illness for the first year.`

Between 2006 and 2013, the rate of emergency department (ED) visits related to mental and substance use disorders increased substantially. This increase was higher for mental disorders visits (55 percent for depression, anxiety or stress reactions and 52 percent for psychoses or bipolar disorders) than for substance use disorders (37 percent) visits. This increasing number of ED visits by patients with mental disorders indicates a growing burden on the health-care delivery system. New methods of surveillance are needed to identify and understand these changing trends in ED utilization and affected underlying populations. Syndromic surveillance can be leveraged to monitor mental health-related ED visits in near real-time. ED syndromic surveillance systems primarily rely on patient chief complaints (CC) to monitor and detect health events. Some studies suggest that the use of ED discharge diagnoses data (Dx), in addition to or instead of CC, may improve sensitivity and specificity of case identification.

Objective: The objectives of this study are to

(1) create a mental health syndrome definition for syndromic surveillance to monitor mental health-related ED visits in near real time;

(2) examine whether CC data alone can accurately detect mental health related ED visits; and

(3) assess the added value of using Dx data to detect mental health-related ED visits.

As syndromic surveillance reporting became an optional activity under Meaningful Use Stage 3 and incentive funds are slated to end completely in 2021, Washington State sought to protect syndromic reporting from emergency departments. As of December 2016, Washington State emergency departments had received $765,335,529.40 in incentive funding, with facilities receiving an average of three payments of $479,974.04 each.1 Considering the public health importance of syndromic surveillance reporting and the fiscal impact of mandatory reporting, the Washington State Department of Health (WA DOH) sought a new statute to require reporting from all emergency departments within the state.

Objective:

To protect syndromic surveillance data reporting from emergency departments in Washington State beyond the cessation of Meaningful Use incentive funding in 2021.

Violence-related injuries are a major source of morbidity and mortality in NC. From 2005-2014, suicide and homicide ranked as NC's 11th and 16th causes of death, respectively. In 2014, there were 1,932 total violent deaths, of which 1,303 were due to suicide (67%), 536 due to homicide (28%), and 93 due to another mechanism of violent injury (5%). These deaths represent a fraction of the total number of violence-related injuries in NC.1 This study examined ED visit data captured by NC DETECT to identify and describe violent injuries treated in NC EDs and compare/contrast with fatalities reported by NC-VDRS.

Objective:

To describe violent injuries treated in North Carolina (NC) emergency departments (EDs) and compare to deaths reported by the NC Violent Death Reporting System (NC-VDRS).