Security aspects of electronic data interchange between a state health department and a hospital emergency department.

Electronic emergency department reporting provides the potential for enhancing local and state surveillance capabilities for a wide variety of syndromes and reportable conditions. The task of protecting data confidentiality and integrity while developing electronic data interchange between a hospital emergency department and a state public health department proved more complex than expected. This case study reports on the significant challenges that had to be resolved to accomplish this goal; these included application restrictions and incompatibilities, technical malfunctions, changing standards, and insufficient dedicated resources. One of the key administrative challenges was that of coordinating project security with enterprise security. The original project has evolved into an ongoing pilot, with the health department currently receiving secure data from the emergency department at four-hour intervals. Currently, planning is underway to add more emergency departments to the project.     

急诊工作人员手卫生调查及监测分析

目的 探讨医院急诊工作人员手卫生情况及提高工作人员手卫生执行率的有效方法,降低医院感染的发生率.方法 按照《医院感染管理规范》的标准,由专职医院感染质控人员对2008年1月-2010年12月该院急诊部工作人员手卫生进行监测,并进行回顾性分析.结果 2008年1月-2010年12月洗手合格率呈逐年递增趋势,分别为89.6％、94.7％及97.6％;护士与医师洗手合格率分别为98.0％、91.3％,两者比较差异有统计学意义(x2=16.17,P＜0.01);全体医护人员与进修培训人员洗手合格率为95.2％和90.3％,两者比较差异有统计学意义(x2=8.30,P＜0.01).结论 通过组织多种形式的医院感染知识培训、改善手卫生设施和健全管理监督制度,提高了全体医护人员手卫生的依从性.     

Hospital records as a data source for occupational disease surveillance: a feasibility study.

To assess the feasibility of using hospital records for occupational disease surveillance and to evaluate the quality of the industry/occupation (I/O) information available in these records, the computer file of all discharge diagnoses from a large health maintenance organization during 1985 was reviewed. The frequencies of discharge diagnoses previously listed as Sentinel Health Events (Occupational), or SHE (O), were calculated and three possible SHE(O) diagnoses--lung cancer, bladder cancer, and toxic hepatitis--were selected for further review. Outpatient charts of patients discharged for each diagnosis were abstracted with regard to I/O information and the discharged patients were interviewed by telephone to obtain a lifetime occupational history. The accuracy of the I/O information obtained from the hospital chart was compared to that obtained by patient interview by number of digits matched on standard classification codes. The frequencies of matches for occupation and industry were greater for "usual" than for "last" categories with both cancer diagnoses, but were similar for "usual" and "last" categories with toxic hepatitis. To assess the proportion of each possible SHE(O) diagnosis that was related to workplace exposures, the I/O information obtained by interview was rated in a blinded fashion by an experienced occupational medicine physician. The highest probability ratings for work-relatedness were noted for lung cancer, primarily due to asbestos exposure. The results of this study suggest that hospital records can be used to identify possible SHE(O); if adequate I/O information is available, then work-relatedness can be assessed. However, the accuracy of I/O obtained from hospital charts is relatively low. The efficient and accurate collection of I/O information from hospital records will require the use of a simple, easily coded instrument to be routinely administered on admission.     

Using the hospital emergency department as a regular source of care

Objectives: to evaluate the proportion of the patients who report the emergency department as their regular source of care and to describe the demographics and health status of this population. Design: A cross-sectional study was performed at the emergency department in two hospitals (around 12.000 visits per year each). Subjects were interviewed using a standardised questionnaire, before and after the emergency department visit. Setting: The medical emergency department of two university hospitals, one in Paris and one in Besanìon (France). Subjects: Each patient aged 15 and more attending the emergency department for a visit during forty randomly selected periods of 12 hours was included. Main outcome measures: Self report of the utilization of the emergency department as a regular source of care. Results: Fourteen percent of the patients cited the emergency department as a regular source of care in Paris, and 3.3% in Besanìon. In Paris, young age, being born outside of France, homelessness or precarious housing, lack of social support in case of illness and lack of health insurance were independently associated with his health care utilization behavior. Conclusions: From a public health point of view, the patients reported to use the emergency department as a primary health care structure should not be considered as inappropriate or abusers. Specific health needs have been found, which would require some continuity of care, a task for which the emergency department is not organised nowadays.     

Internet death notices as a novel source of mortality surveillance data

Concerns about bioterrorism and influenza have focused attention on identifying novel data sources to enhance public health surveillance. The authors evaluated free Pittsburgh Post-Gazette Internet death notices for Allegheny County, Pennsylvania, as a potentially timely source of mortality data. Data abstracted from Internet death notices for 1998-2001 were compared with mortality records from the Pennsylvania Department of Health. Approximately 75% (44,294/60,281) of state records had death notices, and 91% (44,294/48,651) of death notices corresponded to a state record. There was a 2-day median lag from the date of death to online death notice publication. The date of death, gender, age, and name data were nearly 90% accurate and 60-100% complete. Increasing education and age were independently associated with increased Pittsburgh Post-Gazette reporting. Being non-White, female, or a nursing home resident were independently associated with decreased reporting. The Pittsburgh Post-Gazette Internet death notices provided accurate, timely mortality data for nearly three fourths of all Allegheny County deaths.     

Fetal death certificates as a source of surveillance data for stillbirths with birth defects

OBJECTIVE: We assessed fetal death certificates (FDCs) as a source of surveillance for stillbirths with birth defects by linkage with data from the Metropolitan Atlanta Congenital Defects Program (MACDP), a population-based birth defects surveillance system. METHODS: Stillbirths with defects in MACDP were identified from 1994 through 2002 and linked to FDCs. Sensitivity of FDCs for capturing stillbirths with defects was estimated, and predictors for a case being reported were assessed. Concordance for selected variables from each data source was evaluated. RESILTS: Two hundred twenty-four of 257 stillbirths with birth defects in MACDP were linked to an FDC (linkage rate = 87.2%; 95% confidence interval [CI] 82.4, 91.0). Stillbirths of non-Hispanic black and Hispanic/other mothers were more likely to be issued an FDC (odds ratio [OR] = 5.6 [95% CI 1.9, 17.0] and 14.0 [95% CI 1.7, 114.0], respectively). Cases undergoing autopsy were more likely to be issued an FDC (OR = 3.2; 95% CI 1.1, 8.7). Performance of an amniocentesis was poorly recorded on FDCs. The sensitivity and positive predictive value of FDCs for selected classes of defects ranged from 10% to 70% and 25% to 93%, respectively. CONCLUSIONS: Compared to FDCs, MACDP's active case identification improves the ascertainment of stillbirths with birth defects and the quality of certain recorded data.     

Using a spatial filter and a geographic information system to improve rabies surveillance data.

The design and coordination of antirabies measures (e.g., oral vaccine and disease awareness campaigns) often depend on surveillance data. In Kentucky, health officials are concerned that the raccoon rabies epizootic that has spread throughout the east coast since the late 1970s could enter the state. The quality of surveillance data from Kentucky's 120 counties, however, may not be consistent. This article presents a geographic model that can be used with a geographic information system (GIS) to assess whether a county has a lower number of animals submitted for rabies testing than surrounding counties. This technique can be used as a first step in identifying areas needing improvement in their surveillance scheme. This model is a variant of a spatial filter that uses points within an area of analysis (usually a circle) to estimate the value of a central point. The spatial filter is an easy-to-use method of identifying point patterns, such as clusters or holes, at various geographic scales (county, intraurban), by using the traditional circle as an area of analysis or a GIS to incorporate a political shape (county boundary).     

Evaluating the utility of emergency department syndromic surveillance for a regional public health service

Communicable disease monitoring and response activities must be based upon local public health surveillance systems, even during infectious disease emergence, natural disasters, and during bioterrorism events. The NSW Department of Health has developed an emergency department surveillance system intended to monitor important public health conditions during mass gatherings and to identify outbreaks of importance. An evaluation of this system conducted in the Hunter New England region of New South Wales emphasised its usefulness when it was focused on a limited number of syndromes of public health importance and during mass gatherings and public health disaster responses.     

Parental use of a paediatric emergency department as an ambulatory care service

OBJECTIVE: This qualitative study explored the parental attitudes, perceptions and beliefs that play a role in the use of a tertiary paediatric emergency department (PED) when a child has a non-urgent illness. METHOD: Semi-structured, in-depth interviews of 25 parents of children with non-urgent illnesses were conducted in the waiting room of a tertiary PED in Western Sydney in 1998. Inductive analysis was used to identify dominant themes. RESULTS: Parents used their own system of triage to choose the appropriate service for their sick child. The perceived expertise of the tertiary PED, access and parental expectations all appeared to be major factors in parental use of a PED. CONCLUSIONS: The parental choice to attend a PED is a dynamic, complex and unique process and the parental views that underpin this process often diverge from those of health professionals about the most 'appropriate' use of a PED. IMPLICATIONS: A clearer understanding by health professionals of the factors influencing parental choice will promote more effective collaboration with parents and ultimately assist in the decision on the best management option for sick children.     

Evaluation of a system for injury surveillance in Swedish emergency care

A system for continuous and periodic injury surveillance in Swedish emergency care has been evaluated based on a case study of accidental injuries on 2,454 farms during a one year period. The evaluation procedure comprised registry completeness, measurement errors, trend analysis and calculation of risk. The results indicate that the structure of the registry system permits analysis of registry completeness, but further development is needed concerning the staffing and organising problem. The importance of registry inclusion criteria when one is comparing different injury surveillance systems was noted. Limitations applied to calculation of accident frequency rates per million hours work. The results show that there will be a high drop-out rate if the collection of data is not simultaneously combined with an injury control programme. The registry system could serve as a basis for periodic surveys and trend analysis. Further development of a continuous system based on reporting immediately at the injury reception centre should be considered. A coordinated system involving both continuous and periodic data seems to leave the flexibility both to identify certain risk environments or risk groups and to analyse the circumstances involved of specific accidental injuries, e.g. in agriculture.     

Suturing as an advanced skill for registered nurses in the emergency department

OBJECTIVE: Many patients present to emergency departments (EDs) for wounds that require repair by suturing. This study looked at ascertaining the efficacy of Advanced Clinical Nurses' (ACN) suturing dermal lacerations in tertiary, regional and rural ED settings. DESIGN: Convenience sample; prospective questionnaire. SETTING: Three mixed adult and paediatric EDs. These departments were tertiary, regional and rural regional EDs. Participants: Eighty patients requiring sutures for dermal lacerations that were repaired by an ACN. Of them 24 were men and seven were women. Mean age was 40.5 years, with a range of 21-58 years. Ten results from rural ED; six from regional ED; 15 from tertiary ED. Main outcome measure(s): Any differences between suturing standards in rural, regional and tertiary EDs; clinical results of suturing performed by ACNs; local medical officers' satisfaction with wound repair. RESULTS: A total of 31 responses were received. The lacerations were located on the face in 13 patients (42%), the scalp in 10 (32%), an extremity in 2 (6%), and on the trunk in 6 (20%). A total of 196 sutures were required. Local medical officers graded wound repair as 'good' in 24 cases (77%) and adequate in seven cases (23%). There were no wound healing complications reported. CONCLUSIONS: Nurses who complete a standardised training program in wound management and repair are capable of providing high-quality, definitive care for patients who present to EDs with dermal lacerations. This is true irrespective of whether the Registered Nurse is working in a rural, regional or tertiary ED.     

A large-volume nebulizer would not be an infectious source for severe acute respiratory syndrome.

We attempted to detect the presence of airborne SARS-coronavirus (CoV) in a healthcare setting when a patient with SARS used a humidifier or a large-volume nebulizer (LVN). All of the air samples from the humidifier and LVN were found to have negative SARS-CoV-specific DNA products.     

Nursing home revenue source and information availability during the emergency department evaluation of nursing home residents

ObjectivesLack of access to medical information for nursing home residents during emergency department (ED) evaluation is a barrier to quality care. We hypothesized that the quantity of information available in the ED differs based on the funding source of the resident’s nursing home.DesignCross-sectional observational study.SettingSingle academic ED.ParticipantsParticipants were 128 skilled nursing facility (SNF) residents age 65 or older from 12 SNFs.MeasurementsEmergency physicians documented knowledge of 9 essential information items. SNFs were categorized as accepting or not accepting Medicaid.ResultsQuestionnaires were completed for 128 patients, of whom 95 (74%) were from 1 of 8 Medicaid-funded SNFs and 33 (26%) were from 1 of 4 SNFs not accepting Medicaid. Patients from SNFs accepting Medicaid were younger (79 versus 87, P < .001) and less frequently white (62% versus 97%, P < .001). The mean number of 9 possible information items available was lower for patients from SNFs that accept Medicaid (7.13 versus 8.15, P < .001). Emergency providers also reported lower satisfaction regarding access to information for residents from SNFs that accept Medicaid (P < .05). The association between residence in an SNF that accepts Medicaid and lower ED information scores remained after linear regression with clustering by SNF controlling for age, gender, and race. The most common source of information for residents from both types of SNFs was transfer papers from the SNF.ConclusionLess information is available to ED providers for patients from SNFs that accept Medicaid than for residents from SNFs that do not accept Medicaid. Further study is needed to examine this information gap.