Emergency Department Syndromic Surveillance (EDSS): A public health unit perspective. alpha APHEO Meeting Feb 1, 2007

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1 Emergency Department Syndromic Surveillance (EDSS): A public health unit perspective alpha APHEO Meeting Feb 1, 2007

2 Objectives Emergency Department Syndromic Surveillance KFL&A data collection, analysis alerting and investigation examples of use Grey Bruce examples of use Live Demonstration

3 Ontario Pilot Project MOHLTC PHD funded partners include: KFL&A Public Health, Queen s University, PHAC, local acute care hospitals 2 year pilot project Sept/04-Aug/06 Implement and evaluate EDSS system Primary goal Respiratory, GI Live alert investigation Aug/05-present Evaluations comprehensive 3 parts

4 What information are we collecting? Real-time - ED visits to 7 area hospitals (KFL&A and HPE Health Units), admissions to 3 hospitals Date and Time of Visit or Admission Hospital Age/Sex Postal Code (5 digits) Chief Complaint Triage Score Febrile Respiratory Illness (FRI) Screening results Syndromes: Gastroenteritis, Respiratory, Fever/ILI, Asthma, Derm-infectious, Neuro-infectious, Severe Infection, Other

5 Data Analysis Anomaly detection runs 4x daily 4 years of historical data GIS mapping ArcIMS (5-digit PC)

6 Alerts and Investigation Automatic notification of alerts System is monitored 7 days a week As per protocol notify CD/EH staff of anomalies, admissions of interest Resource for CD/EH outbreak investigation Bi-weekly reports to ED, ICP, Lab, public health Approx. 10% of alerts passed on

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11 Using Real-time data to support public health decision-making and monitor the effectiveness of public health interventions Examples of use

12 GI and Respiratory

13 Retrospective Analysis - EARS graph of revised GI syndrome (diarrhea +/- other Sx) for patients visiting KGH and HDH ED - Nov/05 Initial cluster of patients presents to ED with diarrhea +/- other symptoms cultures taken

14 Norovirus GI alert issued Dec 12/06 Increase in ED visits vomit / diarrhea consistent with reports of institutional GI outbreaks in neighbouring health units Alert to ED, infection control, labs, public health Fax to ICP, LTC homes, ambulance services Precautions, virus information, health unit contact #

15 Fig.2 Prospective Monitoring 2005/06 flu season System Alerts Resp - CuSUM Resp - RLS Fever/ILI - CuSUM Fever/ILI - RLS ED visits by Syndrome Positive Influenza Laboratory Results 0 9/1/ /1/ /1/ /1/2005 1/1/2006 2/1/2006 3/1/2006 4/1/ /1/ /1/ /1/ /1/2005 1/1/2006 2/1/2006 3/1/2006 4/1/ December 31, Alert circulated based on - increasing ED visits for respiratory syndrome - increasing FRI positive patients - rise in admissions with respiratory diagnosis 0 9/1/ /1/ /1/ /1/2005 1/1/2006 2/1/2006 3/1/2006 4/1/ January 4, 2006 First Positive Influenza FRI + Fever/ILI Resp Positive Influenza Respiratory Admissions September 2005 to April Resp Admissions 0 9/1/ /1/ /1/ /1/2005 1/1/2006 2/1/2006 3/1/2006 4/1/2006

16 Other Uses Environmental (heat alerts) Disaster Medicine Detect new/emerging diseases Sentinel/event surveillance

17 Grey Bruce ECADS System (NRC) 12 hospitals daily ED visits Area covered: Grey and Bruce Counties (8664 sq km) Population 153,000 plus higher during summer season

18 Other Uses in Grey Bruce BWA s OTC Sales Migraines

19 Cryptosporidium in Grey Bruce Average number of cases per year is 13 (range 7 to 19) Crude incidence rates more than double the provincial average Local cases usually associated with direct exposure to livestock manure or swallowing recreational water One outbreak in region in 1998 associated with Collingwood municipal water system

20 GBHU Cryptosporidiosis Cases # of Cases Week

21 5 4 ECADS GI Alert May 14 & 15 GBHU Cryptosporidiosis Cases 2006 by Week GBHU Alert to EDs re-gi increase - do stool tests J 16 ECADS GI Alert J 14 to 17 GBHU notifies area HUs & MOHLTC of increase CIOS Alert posted # of Cases 3 2 OTC May 27 OTC Jun 4 OTC Aug 2-12 OTC Aug 20-Sept Week in 2006

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24 Conclusions Now have a clearer picture of what is going on in the community System is easy to install, monitor, access, maintain Did not require changes to existing staff, procedures Most ED staff were not aware that the system was in place Opportunity for Public Health and Grey Bruce hospitals to work together, share information

25 Live Demonstration

26 THANKS! Contacts (KFL&A) Dr. Kieran Moore Bronwen Edgar Contacts (Grey Bruce) Dr. Hazel Lynn Alanna Leffley