Devices & Technology

Tracking Disease in the Emergency Department


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Suzi Birz, principal, HiQ Analytics, LLC

Data collected routinely during treatment of a patient in an emergency department can be used to detect patterns which might indicate an act of bioterrorism or any of a vast array of public health concerns from food poisoning at local restaurants to outbreaks of vaccine-preventable diseases.

The Centers for Disease Control and Prevention (CDC) has developed The Early Aberration Reporting System (EARS). EARS was pioneered as a method for monitoring bioterrorism during large-scale events. Its evolution to a standard surveillance tool began in New York City and the Washington D.C. region following the terrorist attacks of September 11, 2001. Efforts have been made at local, state and regional levels as well. This column explores two emergency departments and the surveillance in place.

University of North Carolina

Debbie Travers, Ph.D., RN, FAEN, assistant professor at the University of North Carolina in Chapel Hill shared her experiences with the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), an early event detection and timely public health surveillance system in the North Carolina Public Health Information Network.

North Carolina piloted the ability to monitor, manage and respond to health needs using emergency department data from 1999-2002. In 2002, the NC DETECT was established with federal funds.

NC DETECT receives data on at least a daily basis from five data sources: emergency departments, the statewide poison center, the statewide EMS data collection system, a regional wildlife center and laboratories from the North Carolina State University College of Veterinary Medicine. As of June 2006, 82 of the 112 emergency departments in the state are contributing data.

The contributing emergency departments’ primary purpose in recording the data is to take the best care of patients and run efficient emergency departments. Once the data are submitted, there are a number of secondary uses for the data: public health surveillance for outbreaks or prevention, clinical research and health services research. With NC DETECT, it is possible to take disparate data from disparate systems and do these analyses.

Travers contributes her expertise from emergency room nursing for developing ways to make the best use of the data by creating standardized vocabulary and format, paying particular attention to the emergency department chief complaint.

NC DETECT is helping public health epidemiologists in North Carolina monitor for public health events such as influenza and bioterrorist outbreaks. The contributing emergency departments can access the database and look at their own data or the data in aggregate.

Although not all the contributors are making routine use of the data, Travers continues to make hospitals aware of the tools. She noted that benchmarking is likely to be explored as the next use for the data.

Rush University Medical Center

Julio Silva, M.D., associate clinical chair for the Department of Emergency Medicine at Chicago’s Rush University Medical Center, discussed the role of the Rush Center of Excellence for Bioterrorism Preparedness as a primary resource for the Chicago Department of Public Health, as well as local hospitals, both in planning for and responding to a potential terrorism event or public health emergency.

As early as 1995, researchers at Rush were using the emergency department data to assess clinical impacts. In 2002, the Chicago Department of Public Health denoted Rush a Center of Excellence.

The Center of Excellence for Bioterrorism Preparedness at Rush is directed by an internal committee of clinicians from the following areas: emergency medicine, infectious disease, infection control, microbiology, occupational safety, pediatrics, pharmacy and psychiatry. The Rush committee collaborates with the Chicago Department of Public Health and area hospitals to address key issues through work groups, educational programs, drills, and sharing of resources and ideas.

The team at Rush concentrates its analysis on the earliest available data for trending—the chief complaint. Although traditionally viewed as sentinel event data, Rush researchers have found that looking at the emergency department census data can accurately point to surges in health conditions. If used in real time, these surges can allow clinicians to “sound the alarm earlier,” Silva said.

Like North Carolina, Rush is using data that nurses collect routinely as a byproduct of the care process. In the emergency department, the triage nurse enters the chief complaint. The primary purpose of the data is to take the best possible care of the patient. The data is then sent to the surveillance system. The Rush system uses a categorization system from the University of Pittsburgh to place the chief complaints into eight buckets. The clinical information is used to trend analyses. Alerts are then configured allowing specific surges to be noticed and appropriate clinical personnel notified. Currently, Silva holds this position. Based on the alert, he might investigate. The surges can be examined to determine if they are related to causes that are environmental or manmade.

Silva stated that, to date, the system has been used as a pilot to show proof of concept. He added that the next step is to expand data collection across the geography.

Take-away Messages

Travers and Silva agree that the data that are already collected as part the treatment of patients in the emergency department are critical to understanding the patient base and, when used for secondary and tertiary uses, can provide critical insights into public health outbreaks and acts of terrorism.

Resources

NC DETECT

North Carolina Emergency Department Database

Rush University Medical Center

© 2006. AMN Healthcare, Inc. All Rights Reserved.

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