Establishing an emergency department syndromic surveillance system to support the London 2012 Olympic and Paralympic Games.

BACKGROUND: The London 2012 Olympic and Paralympic Games is a mass gathering event that will present a major public health challenge. The Health Protection Agency, in collaboration with the College of Emergency Medicine, has established the Emergency Department Sentinel Syndromic Surveillance System (EDSSS) to support the public health surveillance requirements of the Games. METHODS: This feasibility study assesses the usefulness of EDSSS in monitoring indicators of disease in the community. Daily counts of anonymised attendance data from six emergency departments across England were analysed by patient demographics (age, gender, partial postcode), triage coding and diagnosis codes. Generic and specific syndromic indicators were developed using aggregations of diagnosis codes recorded during each attendance. RESULTS: Over 339,000 attendances were recorded (26 July 2010 to 25 July 2011). The highest attendances recorded on weekdays between 10:00 and 11:00 and on weekends between 12:00 and 13:00. The mean daily attendance per emergency department was 257 (range 38-435). Syndromic indicators were developed including: respiratory, gastrointestinal, cardiac, acute respiratory infection, gastroenteritis and myocardial ischaemia. Respiratory and acute respiratory infection indicators peaked during December 2010, concomitant with national influenza activity, as monitored through other influenza surveillance systems. CONCLUSIONS: The EDSSS has been established to provide an enhanced surveillance system for the London 2012 Olympics. Further validation of the data will be required; however, the results from this initial descriptive study demonstrate the potential for identifying unusual and/or severe outbreaks of infectious disease, or other incidents with public health impact, within the community.

Wireless handheld computers and voluntary utilization of computerized prescribing systems in the emergency department.

Illegible or invalid hand-written prescriptions can result in avoidable medical errors. Computer-based prescribing can mitigate the problem. An observational study was performed to examine the effect of wireless handheld computers (handhelds) on voluntary utilization of computerized prescribing within an Emergency Department. Handhelds with prescription-writing software were provided to physicians and the numbers of hand-written and computer-generated prescriptions were compared before and after the introduction of the handhelds. The resulting increase in computer-based prescribing was statistically significant and was observed largely among physicians who already used desktop computers for prescribing. The study concluded that handhelds increased voluntary utilization of computerized prescribing, but that the physicians most likely to use handhelds were those who already used desktop-based prescribing.

Clinical information systems: instant ubiquitous clinical data for error reduction and improved clinical outcomes.

Immediate access to existing clinical information is inadequate in current medical practice; lack of existing information causes or contributes to many classes of medical error, including diagnostic and treatment error. A review of the literature finds ample evidence to support a description of the problems caused by data that are missing or unavailable but little evidence to support one proposed solution over another. A primary recommendation of the Consensus Committee is that hospitals and departments should adopt systems that provide fast, ubiquitous, and unified access to all types of existing data. Additional recommendations cover a variety of related functions and operational concepts, from backups and biosurveillance to speed, training, and usability.