Queen’s University Public Health Informatics (QPHI) Team Occupational Health Surveillance Tara Donovan QPHI Surveillance Meeting Exploring Surveillance Opportunities June 13 th, 2008

Innovative, Integrated, Syndromic Surveillance System  Purpose: Develop an automated, integrated, syndromic surveillance system  Method: Use routinely collected electronic Occupational Health (OH) visit data in addition to Emergency Department (ED) visit data

Objectives  Objective 1: Monitor respiratory and gastrointestinal illness activity both within the community (ED) and hospital (OH) To detect outbreaks earlier To facilitate investigations and necessary interventions  Objective 2: Evaluate the ability of the system to detect a sentinel event such as a nosocomial infection or the effect of a community outbreak on staffing levels at the hospital

Ethics  Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board  Privacy Impact Assessment  Compliant with PHIPA

OH Reporting Legislation/ Recommendations  SARS Commission Final Report (Campbell)  Ontario Health Plan for an Influenza Pandemic  Recommendations for Infection Control/ Surveillance MOHLTC (Task Force)  Enteric Disease Surveillance Protocol for Ontario Hospitals (OHA & OMA – CD protocols)

Collected Occupational Health Visit Data  Daily Occupational Health visits at KGH – large tertiary care teaching hospital  Parklane® software  Secure VPN data transfer (Citrix Access Gateway)  Date and Time of Visit  Demographics  Department  Type of visit (i.e. Initial visit/ phone call, Follow-up)  Febrile Respiratory Illness (FRI) Screening results  Condition(s) = Syndromes: Gastrointestinal, Respiratory (Upper/ Lower), FRI, Musculoskeletal, Other

Value of the Integrated System  Integration of OH and ED data  Novel pilot project  Provide early warning of respiratory and gastrointestinal activity - Enhance active specimen collection - Allow managers to prepare for shortages (surge capacity) - Enable earlier public health response - Facilitate infection control procedures  Improve Communication

Value of the Integrated System  Lessons from SARS – electronic/ automated monitoring of HCWs  Improve communication, collaboration, coordination between Public Health and the Acute Care Sector  Bi-weekly reports

Respiratory-related OH Visits

Gastrointestinal-related OH Visits average Alerts # of Initial GI-related ED visits

Components of Compendium 1. Introduction paper – describes the development and implementation process, with a focus on future uses of the integrated system for public health interventions and pandemic and emergency planning

Components of Compendium 2. Norovirus outbreak paper – description of a Norovirus outbreak that occurred among inpatients at the local hospital

Components of Compendium 3. Cost – benefit of the system with a focus on the impact of vaccination rates among staff and the implications for staff absenteeism and associated costs

Components of Compendium 4. Technical Evaluation & Analysis paper – to describe the process of integrating the data into RODS and an explanation of the anomaly detection used for analysis

Components of Compendium 5. System Evaluation – using the Centers for Disease Control (CDC) Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks

Components of Compendium 6. Spatial analysis of Occupational Health visit data – a descriptive paper explaining the development and functionality of a 3D mapping tool which tracks Occupational Health visit reporting of respiratory and gastrointestinal-related illnesses

Mapping – Kingston General Hospital

Floor Plan at KGH

Percent Occupational Health Visits Due to Gastrointestinal Illness March 11 th – 17 th 2007

Components of Compendium 7. Time-series analysis of weekly average Occupational Health and Emergency Department visits

How does OH surveillance contribute to Public Health?  Automatic, concise details of OH visit activity for surveillance of unusual health events or disease outbreaks  Monitoring of multiple data sources  Enhances communication and collaboration with appropriate health care professionals and stakeholders  Early Warning to facilitate public health response (eg. increased Infection Control, implementation of emergency plans)  Awareness of absenteeism  Facilitate ongoing research

Future Opportunities Non-Infectious Disease-Related  Musculoskeletal monitoring – intervention  [i.e. new lift equipment, lift education and techniques]  Needle-stick injury monitoring  Staff Absenteeism

Acknowledgements  Colleagues – Drs. Kieran Moore and Jennifer Carpenter  QUESST/ QPHI  Physician Services Incorporated Foundation  KFL&A Public Health  Kingston General Hospital

Thank You  Questions?