1	Syndromic Surveillance: Retrospective Analysis of Emergency Room Data Tracy L Gustafson, MD Deborah Martin, RN, MN ICPA, Inc. 515 South Capital of Texas Hwy, #240 Austin, TX 78746
2	Syndromic Surveillance Definition Monitor acute syndromes, not diagnoses Purposes Detect bioterrorism attacks early Improve routine reportable disease surveillance Advantage over laboratory surveillance Quicker response and much less expensive New diseases like SARS with no laboratory test
3	E.D. Data Collection Manual methods ED personnel identify "syndrome cases" Enter data into Web-based database Automated methods Import data from ED, triage or billing system Natural language processing of text data like chief complaint, temp, nurse notes Translate ICD9 & ED codes to syndromes
4	Data Analysis Aggregate Analysis Health Dept combines countywide data Looks for clusters in time, place, person Local Analysis Hospital can study patient demographics Hospital can analyze confidential data not transmitted to the health dept Hospital may want to monitor communicable diseases that aren’t reportable
5	Pilot Project Data Emergency Dept. data Large urban Texas hospital All ED visits from 10/2001 - 09/2002 115,569 patient encounters analyzed 24% traumatic 7.6% psychiatric 2.7% OB/GYN
6	Pilot Project Data Flow Enter free text into ED software Import into automated SS software Natural language translation to capture symptoms & diagnoses Group symptoms into syndromes Export de-identified data on selected patients to the Health Dept.
7	Pilot Project "Outbreaks" Flu-like Syndrome Real outbreak - Influenza Pseudo-outbreak - Anthrax GI Syndrome Real outbreaks - Foodborne Encephalitis Syndrome Pseudo-outbreak - West Nile virus
8	Flu-like Syndrome
9	GI Syndrome
10	Encephalitis Syndrome
11	Data of Special Interest to ICP Reportable Diseases Mentioned in 1.4% of Med/Surg visits 34% of these were admitted as inpatients Communicable Disease Control Large number of PPD converters went to the ED for a chest x-ray Routed them directly to TB Clinic
12	Hospital Benefits of Collecting Syndromic Surveillance Data Demonstrates compliance with JCAHO standard EC.1.4.f requires hospital to participate in “cooperative planning…to facilitate timely sharing of information.” Negative data is valuable when counseling the "worried well“ Identifies opportunities for quality improvement in the ED
13	Hospital Benefits of Analyzing Syndromic Surveillance Data Faster recognition of patients who need to be evaluated for isolation Daily data export reduces workload of reporting notifiable diseases Avoid surprises when health dept calls Rapid lookup of patients with unusual or cluster syndromes
14	Conclusions ICP's have a community responsibility ICP should be member of the bioterrorism preparedness task force ICP should be involved in selecting a Syndromic Surveillance system ICP should be involved in SS data analysis ICP should be a key liaison to Health Dept.
15	Conclusions ICP's role cannot be filled by others Only you understand the value of surveillance Only you have epidemiologic skills necessary for analyzing and understanding the results Only you have the ability to take action if a situation requires isolation or quarantine You know computers cannot replace experience Please get involved now!