Issue 3 - June 2002: 10 DOCUMENTED REASONS WHY HOSPITALS MUST PERFORM SYNDROMIC SURVEILLANCE

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10 DOCUMENTED REASONS WHY HOSPITALS MUST PERFORM SYNDROMIC SURVEILLANCE

Notable Quotes: We know what national experts say about the next bioterrorist attack:

"There is no question about it. It is not a matter of if; it is a matter of when, where, and how bad". Michael Osterholm, speaking about the next bioterrorist attack at the SHEA National convention in April 2002. (1)

How will your hospital recognize the next BT or chemical attack? Surveillance is the key to identifying trends and problems. Syndromic surveillance at the point-of-care (e.g., emergency departments) is the best way to begin the process of linking patient problems and public health needs.

Still not convinced? Here are 10 documented reasons to begin performing emergency department surveillance ASAP!

1. JCAHO Expects It

JCAHO expects hospitals to be involved with community-wide "Mitigation activities. In the December 2001 issue of JCAHO Perspectives, Steven Garner, MD is quoted as saying "Surveillance is our greatest weapon in America's new war. It's not a chore. It's a necessity." (2)

In January 2001, JCAHO introduced new emergency management standards that are built on its long-standing disaster preparedness standards. These Environment of Care (EC) standards are effective now and will be included in scoring beginning in 2003.

A number of changes in the Environment of Care (EC) standards speak clearly to the JCAHO's get-serious approach to dealing with terrorist or man-made disasters.

Specifically:

EC 1.4 Intent F "Cooperative planning among healthcare organizations... to facilitate the timely sharing of information about... Names of patients and deceased individuals brought to their organization to facilitate identification and location of victims of the emergency. (3)

EC 1.4 Intent H "Notification of emergencies to external authorities, including possible community emergencies identified by the organization (for example, evidence of a bioterrorist attack)". (3)

2. CDC Endorses it

CDC is in the process right now of allocating to the states millions of dollars for the war on terrorism, some of which will be used to develop "new active or sentinel surveillance activities", including "emergency department visits". (4)

3. Your State Health Department May Soon Require it

Many state and county health departments are reviewing final plans to begin point-of-care surveillance immediately.

4. APIC Promotes it and Provides Guidelines for it

APIC's Bioterrorism Readiness Plan calls for the use of Syndromic Surveillance in Section I. "It may not be practical to await diagnostic laboratory confirmation. Instead, it will be necessary to initiate a response based on the recognition of high-risk syndromes." (5)

In addition, Mike Osterholm, PhD, renowned bioterrorism expert, discusses in an APIC audioconference the importance identifying bioterrorism events through symptoms/surveillance. (6)

5. Reduces Morbidity and Mortality in a Bioterrorist Attack

"One model estimates that if 50,000 persons were infected with Anthrax, 5,000 deaths would result if preventive therapy were started immediately; whereas 32,875 deaths would result if treatment were started six days after release." (7)

6. Reduces Morbidity and Mortality in Naturally Occurring Outbreaks

Assuming that a bioterrorist attack will be a rare occurrence, an even bigger advantage to syndromic surveillance is capturing the naturally occurring events that cause morbidity and mortality every day.

For example, in 1993 Cryptosporidium contaminated the public water supply in Milwaukee, causing significant morbidity and 69 deaths. The outbreak was not identified for at least a month. (8) (9) Syndromic surveillance could have identified the outbreak sooner.

7. Hospitals Don't Have Beds/Staff to Deal with a Large Continuing Outbreak

Syndromic surveillance gives a hospital the opportunity it can't afford to miss; the chance to identify a problem and stop it before it overwhelms the system. Is this needed? YES. The American Hospital Association recently reported that most of the country's emergency department beds are already full, "generally operating at or over capacity". In addition, "1/3 of the hospitals are forced to go on diversion, and 90% of the trauma centers report being overwhelmed." (10)

Does your facility have the additional staff to provide backup if a community-wide outbreak (either intentional or natural) causes illness in your regular staff? Better to identify the presence of a problem early. In addition, syndromic surveillance helps hospitals recognize when their own employees have been exposed to contagious diseases.

8. Syndromic Surveillance Enables Hospitals/Public Health to Provide Advice to the Community

With the information gleaned from syndromic surveillance, public health entities can step into their role as advisors to the community. They can provide advice to assist the public and save hospitals money. That's what Baltimore, a city that practices syndromic surveillance, did when they noticed that large numbers of people were going to the EDs to have influenza treated. Since only the very young or old typically need hospital treatment for flu, they held a press conference explaining how to care for flu. They also urged the public not to come to the ED for flu treatment. The next day, flu visits in the EDs dropped dramatically. (11)

9. Provides Public Information Officers with Factual Information During Potential Outbreaks

Imagine this scenario: West Nile has just arrived in your community. The Public Health Department calls and wants to know everyone you've seen in your ED with fever, headache and malaise so they can begin tracking possible cases. Your Emergency Department software can only give you a list of patients seen and their chief complaint. Whether the outbreak is "real" or just a "scare", you have to waste 40 man-hours of personnel time culling through the printouts by hand. Good syndromic surveillance software would have immediately printed out all patients with this symptom complex, as well as patients who score high on an 'encephalitis' syndrome index. If the numbers are below thresholds, you can help quell the panic. If the numbers are above threshold, you can identify exactly which patients the health department needs to interview.

10. Syndromic Surveillance Saves

Whether you are talking about dollars or lives, syndromic surveillance saves! There is a tremendous payoff between the purchase and use of epidemiologically-sound syndromic surveillance software and the potential catastrophe unrecognized outbreaks (intentional or naturally occurring) can cause.

References

1) http://www.ahcpub.com/ahc_root_html/hot/archive/hic052002.html. Won't get fooled again? SHEA meeting sheds harsh light on anthrax response. Hot Topics in Healthcare. 2002; May

2) JCAHO. Mobilizing America's Health Care Reservoir. Perspectives 2001; 21:12. Pgs 1-24

3) JCAHO. Emergency Management Standard Clarified. Perspectives 2002;22:1, Pgs 6-7

4) http://www.bt.cdc.gov/Planning/CoopAgreementAward/CDC4BTATTACHMENT-B-MASTER-2-14-2002-442pm.asp

5) APIC Bioterrorism Task Force. Bioterrorism Readiness Plan., Pgs 124A-8

6) APIC. APIC News. Jan/Feb 2002. Pgs 7-8

7) R.A. Falkenrath, R.D. Newman, B.A. Thayer. America's Achilles' Heel: Nuclear, Biological and Chemical Terrorism and Covert Attack. The MIT Press, 1998, p.155.'

8) W.R. MacKenzie, N.J. Hoxie, M.E. Proctor, M.S. Gradus, K.A. Blair, D.E. Peterson, J.J. Kazmierczak, D.G. Addiss, K.R. Fox, J.B. Rose, J.P. Davis. A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. New England Journal of Medicine 331:3, July 21, 1994.

9) http://www.engr.wisc.edu/industry/atwork/vol4/drink.html

10) Nemes, Judith, editor. EDs Lack Capacity to Deal with Bioterror, AHA Study Reveals. Bioterror Medical Alert. 2002;1:11.

11) Justen, Ed. Editor. From an interview with Peter Beilenson, Baltimore Health Commissioner. Healthcare Security and Emergency Management. 2002;1:3 Pg 10

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