Biomedical Engineering Reference
In-Depth Information
3 Hospital Syndromic Surveillance
KATHY J. HURT-MULLEN, HOWARD BURKOM, JOE LOMBARDO, SHERYL HAPPEL
LEWIS, NICOLA MARSDEN-HAUG, AND JULIE PAVLIN
Syndromic surveillance systems have been under
development in the last several years as an alter-
native to the types of surveillance systems tradi-
tionally used in hospital and public health settings.
These systems can be described as the monitoring
of available data sources for outbreaks of unspec-
ified disease or of specified disease before the
confirmation of identifying symptoms. Its goal is
to complement existing sentinel surveillance by
identifying outbreaks while keeping false alarm
rates acceptable to the public health infrastruc-
ture. The goals of these systems is the earliest
possible detection of important changes in commu-
nity health status in order to increase the timeliness
of response and limit the morbidity and mortality
experience of the community. Furthermore, they
can also be useful to track and investigate existing
outbreaks as well as provide reassurance of normal
rates of illness in a community.
The potential for an intentional release of a
pathologic agent into a community for the purpose
of causing illness, panic, and terror warrants an
assessment of all tools, information and resources
available for detection of the diseases that could
be caused by such activity. Hospitals have long
used many different surveillance systems for a
wide variety of purposes, including monitoring of
surgical site infections, nosocomial infections, and
acquisition of antibiotic resistant infections, among
others [1]. These systems are usually designed
to capture very specific and well-defined clinical
outcomes with the ultimate goal of monitoring
and improving patient outcomes. They are not
by themselves useful for the purpose of detecting
a broad set of important changes in the health
status of a patient population that could indicate a
community-wide health emergency since there is
no way to predict with certainty what pathogens or
symptom presentation an unknown exposure may
involve.
Public health surveillance is defined tradition-
ally as the ongoing, systematic collection, analysis,
interpretation, and dissemination of data regarding
a health-related event that enables public health
authorities to reduce morbidity and mortality [2].
Such surveillance is conducted for a specified set
of diseases, conditions, or laboratory findings in
addition to recognized clusters, or outbreaks, of
these and yet other health events. Traditional public
health surveillance systems yield very specific and
reliable information, and hospitals have long been
participants in these systems. The major limi-
tations of these traditional systems in detection
of a widespread emergency, such as a bioter-
rorist attack, are comprehensiveness and timeli-
ness [3]. Rather than delaying reporting of illnesses
until confirmation of disease is made, syndromic
surveillance systems group sets of clinical symp-
toms or presentations into syndromes that are
intended to be representative of the kinds of clinical
presentations likely to be manifested by deliberate
exposure to pathogens.
The advent of electronic capture of hospital
encounter data and the widespread dissemination
of computing resources allow for consideration
of new methodologies to meet the needs of both
hospital institutions and the support of public
health organizations' obligation to monitor and
protect their communities' health status. So long as
pertinent information is captured close to the time
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