scholarly journals Building a Better Syndromic Surveillance System: the New York City Experience

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Robert Mathes ◽  
Jessica Sell ◽  
Anthony W. Tam ◽  
Alison Levin-Rector ◽  
Ramona Lall
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Alternative Methods ◽  
Detection Methods ◽  
Syndromic Surveillance System ◽  
Aberration Detection ◽  
Ed Visits

The New York City (NYC) syndromic surveillance system has been monitoring syndromes from city emergency department (ED) visits since 2001. We conducted an evaluation of statistical aberration detection methods currently in use in our system as well as alternative methods, applying six temporal and four spatio-temporal aberration detection methods to two years of ED visits in NYC spiked with synthetic outbreaks. We found performance varied between the methods in regard to sensitivity, specificity, and timeliness, and implementation of these methods will depend on needs, frequency of signals, and technical skill.

Monitoring Emergency Department Visits From Puerto Rico in the Aftermath of Hurricane Maria Using Syndromic Surveillance – New York City, 2017

2019 ◽  
Vol 14 (1) ◽  
pp. 44-48
Author(s):  
Priscilla W. Wong ◽  
Hilary B. Parton
Keyword(s):  
Emergency Department ◽  
New York ◽  
New York City ◽  
Puerto Rico ◽  
York City ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
Situational Awareness ◽  
Syndromic Surveillance System ◽  
Ed Visits

ABSTRACTObjective:Syndromic surveillance has been useful for routine surveillance on a variety of health outcomes and for informing situational awareness during public health emergencies. Following the landfall of Hurricane Maria in 2017, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented an enhanced syndromic surveillance system to characterize related emergency department (ED) visits.Methods:ED visits with any mention of specific key words (“Puerto,” “Rico,” “hurricane,” “Maria”) in the ED chief complaint or Puerto Rico patient home Zip Code were identified from the DOHMH syndromic surveillance system in the 8-week window leading up to and following landfall. Visit volume comparisons pre- and post-Hurricane Maria were performed using Fisher’s exact test.Results:Analyses identified an overall increase in NYC ED utilization relating to Puerto Rico following Hurricane Maria landfall. In particular, there was a small but significant increase in visits involving a medication refill or essential medical equipment. Visits for other outcomes, such as mental illness, also increased, but the differences were not statistically significant.Conclusions:Gaining this situational awareness of medical service use was informative following Hurricane Maria, and, following any natural disaster, the same surveillance methods could be easily established to aid an effective emergency response.

scholarly journals Developing Syndromic Surveillance to Monitor and Respond to Adverse Health Events Related to Psychoactive Substance Use: Methods and Applications

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 65S-72S ◽  
Author(s):  
Michelle L. Nolan ◽  
Hillary V. Kunins ◽  
Ramona Lall ◽  
Denise Paone
Keyword(s):  
Public Health ◽  
New York ◽  
New York City ◽  
York City ◽  
Syndromic Surveillance ◽  
Psychoactive Drug ◽  
Surveillance Systems ◽  
Chief Complaints ◽  
Level Information ◽  
Ed Visits

Introduction: Recent increases in drug overdose deaths, both in New York City and nationally, highlight the need for timely data on psychoactive drug-related morbidity. We developed drug syndrome definitions for syndromic surveillance to monitor drug-related emergency department (ED) visits in real time. Materials and Methods: We used 2012 archived syndromic surveillance data from New York City hospitals to develop definitions for psychoactive drug-related syndromes. The dataset contained ED visit-level information that included patients’ chief complaints, dates of visits, ZIP codes of residence, discharge diagnoses, and dispositions. After manually reviewing chief complaints, we developed a classification scheme comprising 3 categories (overdose, drug mention, and drug abuse/misuse), which we used to define 25 psychoactive drug syndromes. From July 2013 through December 2015, the New York City Department of Health and Mental Hygiene performed daily syndromic surveillance of psychoactive drug-related ED visits using the 25 syndrome definitions. Results: Syndromic surveillance triggered 4 public health investigations, supported 8 other public health investigations that had been triggered by other mechanisms, and resulted in the identification of 5 psychoactive drug-related outbreaks. Syndromic surveillance also identified a substantial increase in synthetic cannabinoid-related visits (from an average of 3 per week in January 2014 to >300 per week in July 2015) and an increase in heroin overdose visits (from 80 to 171 in the first 3 quarters of 2012 and 2014, respectively) in a single neighborhood. Practice Implications: Syndromic surveillance using these novel definitions enabled monitoring of trends in psychoactive drug-related morbidity, initiation and support of public health investigations, and targeting of interventions. Health departments can refine these definitions for their jurisdictions using the described methods and integrate them into existing syndromic surveillance systems.

scholarly journals Advancing the Use of Emergency Department Syndromic Surveillance Data, New York City, 2012-2016

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 23S-30S ◽  
Author(s):  
Ramona Lall ◽  
Jasmine Abdelnabi ◽  
Stephanie Ngai ◽  
Hilary B. Parton ◽  
Kelly Saunders ◽  
...  
Keyword(s):  
Public Health ◽  
New York ◽  
New York City ◽  
Meningococcal Disease ◽  
York City ◽  
Syndromic Surveillance ◽  
Severe Weather ◽  
Use Cases ◽  
Building Collapse ◽  
Ed Visits

Introduction: The use of syndromic surveillance has expanded from its initial purpose of bioterrorism detection. We present 6 use cases from New York City that demonstrate the value of syndromic surveillance for public health response and decision making across a broad range of health outcomes: synthetic cannabinoid drug use, heat-related illness, suspected meningococcal disease, medical needs after severe weather, asthma exacerbation after a building collapse, and Ebola-like illness in travelers returning from West Africa. Materials and Methods: The New York City syndromic surveillance system receives data on patient visits from all emergency departments (EDs) in the city. The data are used to assign syndrome categories based on the chief complaint and discharge diagnosis, and analytic methods are used to monitor geographic and temporal trends and detect clusters. Results: For all 6 use cases, syndromic surveillance using ED data provided actionable information. Syndromic surveillance helped detect a rise in synthetic cannabinoid-related ED visits, prompting a public health investigation and action. Surveillance of heat-related illness indicated increasing health effects of severe weather and led to more urgent public health messaging. Surveillance of meningitis-related ED visits helped identify unreported cases of culture-negative meningococcal disease. Syndromic surveillance also proved useful for assessing a surge of methadone-related ED visits after Superstorm Sandy, provided reassurance of no localized increases in asthma after a building collapse, and augmented traditional disease reporting during the West African Ebola outbreak. Practice Implications: Sharing syndromic surveillance use cases can foster new ideas and build capacity for public health preparedness and response.

scholarly journals Comparison between HL7 and Legacy Syndromic Surveillance Data in New York City

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Janette Yung ◽  
Promise Nkwocha ◽  
Anthony W. Tam ◽  
Ramona Lall ◽  
Robert Mathes
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Syndromic Surveillance ◽  
Data Format ◽  
Syndromic Surveillance System ◽  
Data Completeness ◽  
Data Formats ◽  
The City ◽  
Continue Monitoring

As part of the Center for Medicare and Medicaid Services Electronic Health Record Incentive Program, otherwise known as Meaningful Use, many New York City emergency departments participating in the city syndromic surveillance system have switched or are in the process of switching data format from text files to HL7 Messaging Standard Version 2.5.1. We evaluated data completeness, quality, and content from hospitals that are sending in both data formats in parallel. Although the sample size was small (n=4 hospitals), we found data completeness and quality improved as hospitals shifted to HL7 messaging. We will continue monitoring hospitals as they upgrade to this new format.

scholarly journals Using Emergency Department Data to Conduct Dog and Animal Bite Surveillance in New York City, 2003–2006

2012 ◽  
Vol 127 (2) ◽  
pp. 195-201 ◽  
Author(s):  
Brooke Bregman ◽  
Sally Slavinski
Keyword(s):  
Emergency Department ◽  
New York ◽  
New York City ◽  
York City ◽  
Surveillance System ◽  
Syndromic Surveillance ◽  
The United States ◽  
Chief Complaint ◽  
Free Text ◽  
Animal Bites

Objectives. Most animal bites in the United States are due to dogs, with approximately 4.7 million reports per year. Surveillance for dog and other animal bites requires a substantial investment of time and resources, and underreporting is common. We described the use and findings of electronic hospital emergency department (ED) chief complaint data to characterize patients and summarize trends in people treated for dog and other animal bites in New York City (NYC) EDs between 2003 and 2006. Methods. Retrospective data were obtained from the syndromic surveillance system at the NYC Department of Health and Mental Hygiene. We used a statistical program to identify chief complaint free-text fields as one of four categories of animal bites. We evaluated descriptive statistics and univariate associations on the available demographic data. The findings were also compared with data collected through the existing passive reporting animal bite surveillance system. Results. During the study period, more than 6,000 animal bite patient visits were recorded per year. The proportion of visits for animal bites did not appear to change over time. Dog bites accounted for more than 70% and cat bites accounted for 13% of animal bite patient visits. Demographic characteristics of patients were similar to those identified in NYC's passive surveillance system. Conclusions. Our findings suggest that the use of ED data offers a simple, less resource-intensive, and sustainable way of conducting animal bite surveillance and a novel use of syndromic surveillance data. However, it cannot replace traditional surveillance used to manage individual patients for potential rabies exposures.

scholarly journals Monitoring child mental health related emergency department visits in New York City

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Don Olson ◽  
Willem Van der Mei ◽  
Sungwoo Lim ◽  
Carol Yoon ◽  
Melissa Kull ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
New York ◽  
New York City ◽  
York City ◽  
Syndromic Surveillance ◽  
Surveillance Data ◽  
Age Group ◽  
Health Related ◽  
Ed Visits

ObjectiveTo assess the use of syndromic surveillance to assess trends inmental health-related emergency department (ED) visits amongschool-aged children and adolescents in New York City (NYC).IntroductionFrom 2001-2011, mental health-related hospitalizations and EDvisits increased among United States children nationwide [1]. Duringthis period, mental health-related hospitalizations among NYCchildren increased nearly 23% [2]. To estimate mental health-relatedED visits in NYC and assess the use of syndromic surveillance chiefcomplaint data to monitor these visits, we compared trends from anear real-time syndromic system with those from a less timely, codedED visit database.MethodsThe NYC ED syndromic surveillance system receives anonymizedpatient chief complaint and basic demographic data for nearly everyED visit citywide to provide timely surveillance information tohealth authorities. Using NYC ED syndromic surveillance datafrom 2003-2015, we applied previously developed definitions forgeneral psychiatric syndromes. We aggregated ED visits by agegroup (5-12 years, 13-17 years, and 18-20 years), geography, andtemporality. Syndromic data were compared with Statewide Planningand Research Collaborative System (SPARCS) data from 2006-2014which reported mental health diagnosis (ICD-9), treatment, service,and basic demographics for patients visiting facilities in NYC. Usingthese two data sources, we compared daily visit patterns and annualtrends overall as well as stratified by age group, area-based poverty(ZIP code), and time of visit.ResultsBoth syndromic surveillance and SPARCS data for NYC showedan increasing trend during the period. While both showed relativeincreases with similar slopes, mental health-related chief complaintdata captured fewer overall visits than the ICD-9 coded SPARCSdata. Trends in syndromic data during 2003-2015 differed by age-group and area-based poverty, e.g., among children ages 5-12 yearsthe annual proportion of mental health-related ED visits increasedroughly 3-fold from 1.2% to 3.8% in the poorest areas, which wasgreater than the increase in the richest areas (1.7% to 2.6%). Seasonal,day-of-week, and school holiday patterns found far fewer visits duringthe periods of NYC public school breaks (Figure).ConclusionsWe conclude that syndromic surveillance data can provide areliable indicator of mental health-related ED visit trends. Thesefindings suggest potential benefit of syndromic surveillance data asthey may help capture temporal and spatial clustering of events in amuch more timely manner than the >1 year delay in availability ofED discharge data. Next steps include a qualitative study exploringthe causes of these patterns and the role of various factors drivingthem, as well as use of patient disposition and matched data to bettercharacterize ED visit patient outcomes.

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