Respiratory Syndromes Surveillance System to monitor Emergency Department crowding in Genoa, Italy
Cecilia Trucchi, Chiara Paganino, Andrea Orsi, Paola Canepa, Valeria Faccio, Emanuela Rappazzo, A Battistini, F Podestà, P Moscatelli, Alessandra Morando, Filippo Ansaldi · European Journal of Public Health · 2015
Background Overcrowding of the emergency department (ED) is a significant and multifactorial public health problem in Europe, especially during the winter season, when the influenza epidemic occurs. The lack of indicators able to monitor, predict and quantify the ED overcrowding affects early response. The aim of the study is to evaluate the performance of a chief complaint syndrome surveillance system (SSS) using data from the ED records of Influenza-like Illness (ILI) and Low Respiratory Tract Infections (LRTI) accesses as tool of effective management of ED overcrowding. Methods For the 36-month period from May 2012 to April 2015, access data for ILI and LRTI at the referral teaching hospital I.R.C.C.S. A.O.U. San Martino–I.S.T., Genoa, Italy obtained by SSS and detection of respiratory viruses in the community obtained by regional reference laboratory were compared with the number of ED stretchers at 8:00a.m. Syndrome coding, data capture, transmission and processing, statistical analysis to assess indicators of disease activity and alert thresholds, and signal response were operatively used from 2007 at regional level and revised by Triple S projects. Results Despite ILI and LRTI accesses were less than 5% out of >95,000 yearly accesses for all cause, SSS indicators were strongly correlate with ED stretchers counts. LRTI indicators odds ratios (ORs) were >10 times higher in comparison with ILI ORs in predicting ED overcrowding. During influenza virus circulation, when ILI and LRTI accesses increased, the implementation of extraordinary bed management strategies (ordinary hospitalization block, extension of ward admitting ED patients, ecc.) allowed to interrupt the growth of ED stretchers. Conclusions SSS integrated with a rapid detection of the etiological agent of respiratory infection could be an effective, specific and sensitive tool for monitoring, predicting and managing ED overcrowding. Key messages Syndrome surveillance based on ED records of ILI and LRTI could useful to monitor, predict and manage ED overcrowding Accesses for LRTI strongly contribute to ED overcrowding