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
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.
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.
North Carolina Emergency Department Database
Rush University Medical Center
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