Emergency Department (ED)

Utilization and overcrowding of EDs has been a prominent component of the health care reform debate in the United States for the last several years. In Virginia, the ED utilization rate has increased 27.5% between 2000 and 2012 from 34.5 visits to 44.0 visits per 100 persons. Individuals with high frequency utilization of EDs account for a disproportionate number of visits, which can place burden on already strained health care resources. This study aims to use existing syndromic surveillance data received electronically by the Virginia Department of Health (VDH) to describe demographic and utilization characteristics among chronic high frequency ED users in order to better understand the health complaints affecting this population.

Objective

Leverage existing syndromic surveillance data to characterize the population of chronic high frequency emergency department (ED) users and to understand the health complaints for which this population utilizes emergent health care services.

Over several months in 2012, NYC DOHMH syndromic surveillance staff met with directors of all 49 participating EDs in our syndromic system to collect information on their health information systems coding practices. During these interviews, ED directors expressed interest in receiving summary reports of the data they send to the syndromic unit, such as number of ED visits, most common complaints, and temporal and spatial trends. This effort was done to increase communication and cooperation between the syndromic unit and the EDs that provide data to the syndromic system.

Objective

To share monthly summary reports of syndromic data to participating EDs in NYC.

A retrospective analysis of emergency department data in NC for drug and opioid overdoses has been explained previously [1]. We built on this initial work to develop new poisoning and surveillance reports to facilitate near real time surveillance by health department and hospital users. In North Carolina, the availability for mortality and hospital discharge data are approximately one and two years after the event date, respectively. NC DETECT data are near real time and over 75% of ED visits receive at least one ICD-9-CM final diagnosis code within two weeks of the initial record receipt.

Objective

Twelve new case definitions were added to the NC DETECT Web Application to facilitate timely surveillance for poisoning and overdose. The process for developing these case definitions and the most recent outputs are described.

After the major impact of the 2003 heat wave, France needed a reactive, permanent and national surveillance system enabling to detect and to follow-up various public health events all over the territory including overseas. In June 2004, the French syndromic surveillance system based on the emergency department (ED) has been implemented by the national institute for public health surveillance (InVS). Beginning with 23 ED in 2004, the network has progressively included new ED and several steps have contributed to accelerate this permanent increase. A first evaluation of this data source was conducted for the specific surveillance of heat wave.

Objective

Implemented 10 years ago, the French emergency department surveillance system (Oscour Network) has been assessed using four major evaluation criteria in syndromic surveillance: stability, coverage, data quality and utility.

Within the UK, previous syndromic surveillance studies have used statistical estimation to describe the activity of respiratory pathogens. The Emergency Department Syndromic Surveillance System (EDSSS) was initially developed in preparation of the London 2012 Olympic and Paralympic Games and has continued as a standard surveillance system, with expanding coverage across England and Northern Ireland. All reporting to this system is completely passive, with no extra work required within the ED. The data collection includes the diagnosis for each attendance, where available, using the coding system in use locally. The coding varies by ED with ICD- 10, Snomed-CT and the less detailed NHS Accident and Emergency Diagnosis Tables all in use. The use of diagnosis coding systems with differing levels of detail creates the need to have a variety of syndromic indicators to make best use of the data received.

We aim to describe the trends in respiratory attendances, and their comparison to the known circulating pathogens identified though laboratory surveillance to establish if any single syndromic indicator may be attributed to any one pathogen in particular. We also aim to describe the flexibility in the development of EDSSS syndromic indicators to best fit the data received.

Objective

Can syndromic surveillance using standard emergency department data collected using automated daily extraction be used to describe and alert the onset of the seasonal activity of named respiratory pathogens within the community?

Motor vehicle crashes (MVC) are a significant public health problem in Nebraska. These events cost Nebraska $1.6 billion a year, are the leading cause of injury death, and the fourth leading cause of injury hospital treatment in the state. Speeding, driving under the influence, distracted driving, and adverse weather are the main causes of MVC in Nebraska. Effective prevention efforts to reduce MVC related deaths and injuries depend greatly on a surveillance system that monitors the frequency of these events so stakeholders may ascertain the MVC related causes and impact on the state. Currently, the Nebraska Department of Health and Human Services (NDHHS) Crash Outcome Data Evaluation System (CODES) monitors MVC related death and injuries by linking the following databases statewide crash data, hospital discharge data (HDD), trauma registry, emergency medical system (EMS) data and death certificate data. Although this system has been effective in identifying the causes of MVC-ralated injuries and supporting community based highway safety programs, it is limited by the lack of immediate availability of data. ‘An ED based SS system could potentially be used to enhance MVC injury surveillance by allowing the timely detection of clusters, anomalies and trends. Therefore, and ED SS system could be incorporated to support an efficient and rapid prevention response to MVC-related injuries.

Objective

The objective of this pilot study is to demonstrate the value of emergency department (ED) syndromic surveillance (SS) data to aid the surveillance of motor vehicle crash (MVC) related injuries in Nebraska.

Utilization of local surveillance data has been shown to help risk stratify patients presenting to the emergency department presenting with GAS pharyngitis or meningitis. (1, 2) Adolescents frequently present to the emergency department (ED) with symptoms that may be associated with a sexually transmitted infection (STI). (3) When ED providers perceive high local rates of STI and low rates of follow-up, empiric treatment is considered. This strategy may result in unnecessary treatment. Knowledge of the local spatial distribution of adolescents with STIs diagnosed in local pediatric emergency departments EDs may enhance risk stratification and allow targeted testing and/or treatment among future ED patients in whom STI is considered.

Objective

(1) To describe the spatial distribution of adolescents with EDdiagnosed STIs in a large urban area with a high prevalence of STI

(2) To compare census block groups and identify “hot spots” of STI.

 

Syndromic surveillance generally refers to the monitoring of disease related events, sets of clinical features (i.e. syndromes), or other indicators in a population. Originally conceived as a tool for the early detection of potential bioterrorism outbreaks, syndromic surveillance is also used by health departments as a tool for monitoring seasonal illness, evaluating health interventions, and other health surveillance activities. Over the past decade, the Tennessee Department of Health (TDH) has utilized syndromic surveillance at the jurisdictional level. These standalone, jurisdictional systems utilized chief complaint data from local emergency departments (EDs) and the Early Aberration Reporting System (EARS) developed by CDC. Some jurisdictions integrated other local data for analysis in EARS including 911 call center data, over the counter drug sales, and other non-traditional data sources. The analyses conducted on the data varied from jurisdiction to jurisdiction. CDC dismantled the EARS program in 2011, prompting the need for a complete syndromic surveillance overhaul. TDH decided to implement a centralized, statewide system that would maintain all the capabilities that jurisdictions currently had while allowing for statewide data analysis and aggregation. During this implementation process, TDH has been balancing the short term goal of supporting and maintaining the existing jurisdictional systems while moving forward with acquiring a statewide syndromic surveillance solution and establishing the infrastructure to support it.

Objective

To share lessons learned in Tennessee during its transition from a jurisdictional syndromic surveillance system to a state-wide, centralized system.

 

The MSSS, described elsewhere, has been in use since 2003 and records ED chief complaint data. As of September 2014, there were 88/136 hospital EDs enrolled in MSSS, capturing 83% of the annual hospital ED visits in Michigan.

On April 1, 2014 the Healthy Michigan Plan (HMP) was launched. HMP provides healthcare benefits to low-income adult residents who do not qualify for Medicaid or Medicare. The plan incorporates both federally and state mandated Essential Health Benefits, which includes emergency services.

As insurance coverage expands, more people will have the ability to utilize the services of primary care and other providers. In particular, this will affect previously uninsured, low-income populations who are disproportionately affected by chronic disease.

We question if access to these services will affect the utilization of emergency services as more people will have a medical home to manage and prevent diseases that may otherwise become an emergent issue. Furthermore, this increased access to health care services will expand care options for urgent but not emergent issues beyond EDs. Conversely, as more people acquire health care benefits the demand for primary care services may exceed the level of access to these services which may lead to an increase of ED utilization for primary care.

Objective

The purpose of this work is to use the Michigan Syndromic Surveillance System (MSSS) to assess emergency department (ED) utilization before and after the April 2014 implementation of the Healthy Michigan Plan, an expanded Medicaid program.

The number of US adults who use the internet to access health information has increased from about 95 million in 2005 to 220 million in 2014. The public health impact of this trend is unknown; in theory, patients may be able to better help the doctor arrive at the correct diagnosis, but self-diagnosed patients may also inappropriately self-treat or delay going to the doctor. The current study examines trends in self-diagnoses in NYC EDs, identifies the demographic characteristics of self-diagnosed patients, and compares hospital admission rates of self-diagnosed patients with those who do not self-diagnose.

Objective

To monitor self-reported diagnosis from New York City (NYC) emergency department (ED) chief complaints (CC).