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Emergency Medicine
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Phone: 617.355.6637

February, 2003

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Expanding the scope
Syndromic surveillance tracks bioterror, day-to-day emergencies

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Pediatrician-in-Chief Gary Fleisher, MD, explains how ED Scope, allows the Emergency Deptartment to track signs of bioterrorism.

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Clinicians in Children’s Hospital Boston’s Emergency Department (ED) who helped develop a software program to track signs of bioterrorism have found that it also provides valuable information for predicting day-to-day emergencies.

Known as EDScope, the project began last summer as part of the hospital’s continuing efforts at “syndromic surveillance,” or surveying hospitals and clinics for clusters of particular diseases that may signal a bioterrorist attack.

“The challenge has always been that people come into the ED individually, not all at once,” says Michael Shannon, MD, MPH, interim chief of Emergency Medicine. “So it was hard to determine if there was a change in the pattern of a given set of symptoms. EDScope lets us see those patterns and identify potential problems before they get out of hand.”

The software was developed by the hospital’s Informatics Program, implemented by the Information Services Department, and gives ED staff a real-time look at the types of problems treated on a given day. The symptoms of each patient admitted to the ED are entered into the computer in 14 basic categories (such as rash or meningitis). Physicians, nurses and other staff then can consult a computerized readout—which is updated every 15 minutes—that shows all the activity in the ED that day and for the previous week.

The system then compares the data for a given day with information from the more than 500,000 Children’s ED visits in the last 11 years. If the computer analysis finds, for example, that more people have been admitted for respiratory symptoms than is normal for that time of the year and day of the week, a red flag alerts staff that a pattern may be developing.

Since the system went into use, Dr. Shannon and his ED colleagues have also found they can use the information to predict more common emergency room activities with high accuracy. “We’ve always known that we got more trauma patients in the summer and patients with the flu in the winter,” says Dr. Shannon. “But with EDScope, we can predict what specific types of patients we’re likely to get on any given day next month or next April.”

Dr. Shannon would like to explore the use of the software at other hospitals in the area so the data is that much more useful. “Right now there’s no place else in the country that can do this, but our goal is to share information with other hospitals and create a network for identifying disease patterns.”