Queens University Public Health Informatics QPHI Team Occupational

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

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

Objectives o Objective 1: Monitor respiratory and gastrointestinal illness activity both within the community (ED) and hospital (OH) n To detect outbreaks earlier n To facilitate investigations and necessary interventions o 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 o o o Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board Privacy Impact Assessment Compliant with PHIPA

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

Collected Occupational Health Visit Data o o o Daily Occupational Health visits at KGH – large tertiary care teaching hospital Parklane® software Secure VPN data transfer (Citrix Access Gateway) o o o 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 o o 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 o Lessons from SARS – electronic/ automated monitoring of HCWs o Improve communication, collaboration, coordination between Public Health and the Acute Care Sector o Bi-weekly reports

Respiratory-related OH Visits

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

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 3 D 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

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? o o o 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 o Musculoskeletal monitoring – intervention o [i. e. new lift equipment, lift education and techniques] o Needle-stick injury monitoring o Staff Absenteeism

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

Thank You o Questions?