Emergency Department (ED)

During March-May 2013, 14 overdose deaths occurred in RI that were caused by acetyl fentanyl, a novel synthetic opioid about five times more potent than heroin1. Ten of these deaths were clustered in March, causing a significant increase over baseline of monthly illicit drug overdose deaths in RI1. Overdose deaths are well described in RI by forensic toxicology testing results. However, the overall number of ED visits associated with this event was unknown. We used RODS data retrospectively to characterize overdose related ED visits in RI and to analyze trends.

Objective

Determine if the Rhode Island (RI) Real-time Outbreak and Disease Surveillance (RODS) system (a syndromic surveillance system) identified an increase in overdoses during a known cluster of illicit drug overdose deaths in RI and characterize emergency department (ED) overdose visits during the 15 month period prior to and including the known cluster.

In 2003, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia estimated that approximately 1 million people in the United States were living with HIV/AIDS, and that approximately 25% these were undiagnosed and unaware of their HIV infection. For many such patients the emergency department may be the only part of the health care system that is utilized. In 2006, the CDC revised their recommendations for HIV testing in a variety of care settings including the emergency department (ED). Early identification and treatment improves survival for patients with HIV. Earlier testing programs including those provided in the ED may lead to earlier detection and further reduction in the transmission of HIV in the United States. (1,2,3,4,5) High risk patients should recieve screening for HIV and those patients who have a lab test for GC/chlamydia represent a high risk patient popualtion.(4) While the ED is a frequent health care access point for patients seeking evaluation for sexually transmitted diseases, ED providers may not be following guidlines for HIV testing in high risk patients.

Objective

To assess compliance with CDC and USPSTF guidelines for HIV testing in a regional cohort of emergency departments.

In 2003, the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia estimated that approximately 1 million people in the United States were living with HIV/AIDS, and that approximately 25% these were undiagnosed and unaware of their HIV infection. For many such patients the emergency department may be the only part of the health care system that is utilized. In 2006, the CDC revised their recommendations for HIV testing in a variety of care settings including the emergency department (ED). Early identification and treatment improves survival for patients with HIV. Earlier testing programs including those provided in the ED will lead earlier detection and further reduction in the transmission of HIV in the United States. (1,2,3) The analysis was focused on ED providersÕ knowledge and attitudes towards routine HIV testing, perceived barriers to HIV testing.

Objective:

To evaluate ED staff attitudes and potential barriers towards ED based POC HIV testing in an urban academic ED prior to implementing an ED based POC HIV test.

Monitoring trends of respiratory illnesses via syndromic surveillance in SC is performed on a daily basis. SC Syndromic Surveillance primarily utilizes emergency department data, and provides situational awareness regarding broad syndrome categories among hospitals in the state. Respiratory illnesses represent a significant public health burden, causing the second highest number of outbreaks reported in SC. Since syndromic surveillance can potentially serve as an earlier indicator of outbreaks,1 it is beneficial to assess seasonality of respiratory illnesses to identify illness clusters early to mobilize a rapid response.

Objective

To assess the temporal patterns of respiratory illnesses in South Carolina (SC) using syndromic surveillance emergency department (ED) data.

In November of 2011, the local Public Health unit responsible for the Edmonton area (population 1.2mil) was alerted to an individual meeting the case definition for measles in the ED. A key part of the management strategy was to identify contacts to the index case, perform a risk assessment and, if applicable, inform them of the risk. Given the transmission characteristics, the risk for this group was defined as those present within the geographic area/environment of the index case within a specified time period. Public Health utilized the established manual lookup of hospital records and piloted an automated data query through the syndromic surveillance system, ARTSSN. This served as opportunity to validate the ability to generate a contact list, based on risk geography and time, of the ARTSSN system, and to compare the timeliness of each result.

Objective

Following a clinical case of measles presenting to an urban emergency department (ED), the local health authority sought to identify all patients that might be at risk for disease. This list of contacts was generated through a manual search of hospital records and through a piloted automated data query of the health authority's syndromic surveillance system, Alberta Real Time Syndromic Surveillance Net (ARTSSN). The purpose of this pilot study was to: 1) compare the completeness of the two lookup methods and, 2) describe the time requirements needed for each method.

The nature of Emergency Room services makes the patients' visits hard to predict and control and the services incur high costs. Chronic patients should not require urgent care to treat their chronic illness, if they were properly managed in primary care. We track frequency of emergency room visits by chronically ill when the primary complaint of record is their chronic condition. We use a record of institutional insurance claims collected in over 400 hospitals in California between 2006 and 2010. We identify dimensions of data that provide statistically significant differences of utilization between strata. We found particularly significant differences in resource utilization subject to type of insurance coverage carried by the patient, and subject to patient's age. We studied Diabetes, Asthma, and Arthritis patients from 8 age groups spanning ages 5 to 85, and 13 insurance payer types.

Objective

To study patterns of utilization of emergency care resources by chronically ill in order to identify efficiency and quality of care improvement opportunities.

Emergency management during a disaster entails innumerable challenges. Each disaster uniquely shapes the types and timing of information needed both to manage the disaster and to measure the impact on available resources, the environment, and community systems. Traditional public health surveillance methods typically preclude providing a real-time, comprehensive estimate of public health impacts related to the disaster while the disaster is unfolding. Traditional methods can also be resource intensive, costly, require active cooperation of medical systems involved in a disaster response, and are often conducted post-disaster.

Syndromic surveillance of emergency department chief complaints and over-the-counter medication sales was reinstituted in the Austin area in the fall of 2010. In 2011, the Austin area was hit with three natural disasters: a winter ice storm; a summer of extreme heat/extended drought; and a week of significant wildfires. Each disaster varied greatly in type, size, intensity, and duration. The Austin/Travis County Health and Human Services Department, in partnership with Austin/Travis County EMS, was able for the first time to provide near-real time data to emergency managers on the potential health impact during each of the 2011 disasters using the syndromic and EMS electronic data systems. The data were used to provide situational awareness and guide selected response actions during the course of the disaster, as well as, document potential areas for future mitigation efforts.

Objective

Using case studies of three natural disasters that occurred in the Austin, Texas Metro area in 2011, demonstrate the role syndromic surveillance and emergency medical services data played during the response to each different type of disaster.

The Oregon Health Authority (OHA), in collaboration with the Johns Hopkins University Applied Physics Laboratory, implemented a syndromic surveillance system, Oregon ESSENCE. A critical component to developing and growing this statewide system is obtaining buy-in and voluntary participation from hospital Emergency Departments (EDs). This process involves approval at multiple levels within a hospital facility from administration to information technology staff responsible for sending electronic ED data to the Oregon ESSENCE system. Therefore, developing marketing materials that appeal to a wide range of recruitment audiences is a key step in obtaining stakeholder buy-in. OHA adopted the ISDS and CDC syndromic surveillance standards for the public health objective of the Center for Medicaid and Medicare Services (CMS) Meaningful Use Programs. However, Oregon hospitals will not receive financial incentive to participate in Oregon ESSENCE from CMS until 2014 during stage two of Meaningful Use. Consequently, this project's early years will focus on obtaining voluntary participation from hospitals.

Objective

Encourage hospitals to participate in OHA emergency department syndromic surveillance system, Oregon ESSENCE.

Syndromic surveillance systems were designed for early outbreak and bioterrorism event detection. As practical experience shaped development and implementation, these systems became more broadly used for general surveillance and situational awareness, notably influenza-like illness (ILI) monitoring. Beginning in 2006, ISDS engaged partners from state and local health departments to build Distribute, a distributed surveillance network for sharing de-identified aggregate emergency department syndromic surveillance data through existing state and local public health systems. To provide more meaningful cross-jurisdictional comparisons and to allow valid aggregation of syndromic data at the national level, a pilot study was conducted to assess implementation of a common ILI syndrome definition across Distribute.

Objective

Assess the feasibility and utility of adopting a common ILI syndrome across participating jurisdictions in the ISDS Distribute project.

In the summer of 2001, New Jersey (NJ) was in the process of developing surveillance activities for bioterrorism. On September 11, 2001, the U.S. suffered a major terrorist attack. Approximately a month later, Anthrax-laced letters were processed through a New Jersey Postal Distribution Center (PDC). As a result of these events, the state instituted simplistic surveillance activities in emergency departments (ED's). Over time, this initial system has developed into a broader, more streamlined approach to surveillance that now includes syndromic data e.g., Influenza-like illness (ILI) as well as the use of technology (automated surveys, real-time data connections, and alert analysis) to achieve surveillance goals and provide daily information to public health partners in local health departments and DHSS response colleagues.

Objective

To describe the improvements in New Jersey's Emergency Department surveillance system over time.