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a pragmatic approach to timely disease surveillance in the emergency department

by:QUESTT     2020-07-27
Computerized emergency department (ED)
Logs have been used for more than 20 years.
Nevertheless, the public health authorities have failed to make full use of this important monitoring tool.
Location: Alice Ho Miao Ling\'s hospital (AHNH)
It is a community hospital with 500 beds and 350-400 patients are educated every day in Hong Kong.
Intervention: following the implementation of the Ed computerized management system in Hong Kong in 1997, AHNH monitors common reports using standard statistical software.
Deviations from the average attendance frequency were reported to the public authorities.
Experience during the calendar years 1999 and 2000 was reported.
Results: in addition to common seasonal changes such as respiratory infections and stomach problems, it seems necessary to take specific public health interventions, hand, foot, mouth and mouth disease, chickenpox, in performance related to dog bites, spikes, measles, injured scooter.
Discussion: ED computer information system should be an effective tool for disease monitoring.
In communities where this is not the case, public health authorities should insist on timely access to and reporting of educational attendance data.
He miu Ling naopin Hospital (AHNH)
It is a 500 bed community hospital in the New Territories of Hong Kong and opened in 1997.
It serves about 300 people and conducts 350-400 ED census per day.
Due to the lack of primary care network development in Hong Kong, there are a large number of minor cases.
The ED computer system used by the computer system in Hong Kong was developed locally by the Hospital Authority.
The system was first introduced to the Prince of Wales Hospital in 1993 and a new module was added in 1997 (
Clinical Management System.
This new module was piloted in AHNH.
The new version includes capturing diagnostic codes, medication sequence, and professional information.
Barcode * technology is used for patient identification.
Clinical data, including scanning patient medical records, can be shared through intranet technology at 4000 clinical workstations in all public hospitals in Hong Kong.
Data entry is entered by the clerical staff.
Specific data such as triage time, waiting time, discharge destination, and other clinical data were obtained by the nursing staff.
The doctor is responsible for capturing the diagnostic code in version 9 of the International Classification of Diseases (ICD-9)
Format, discharge medication, discharge summary.
The patient identification is the Hong Kong identity card number (HKID)
For every patient in Hong Kong, this is mandatory and unique.
Patient selection is done by scanning the barcode using the patient label.
Training courses were organized to improve the quality of data.
In addition, in computer programs, common diagnostic codes for about 100 ED are grouped together to facilitate the entry of data by the doctor.
Doctors have more than 99% Compliance with diagnostic codes, which is closely monitored.
The intervention uses standard database software, extracts data from the ED database and arranges them into tables based on diagnostic groupings.
Common and Sentinel diagnostics are tracked over time.
Calculate the monthly average attendance number and send computer-generated reports to key personnel when the standard deviation variance is greater than 2 (
Director of education and hospital administration)
Necessary action
The hardware is IBM (Pentium 300 MHz (
Computer developed by international commercial Machine Company)
PC compatible with 64 m RAM and 10g hard drive, printing reports using a black and white laser printer.
The system software is Microsoft Windows 98.
Microsoft vision Foxpro version 6. 0 (
Database Engine developed by Microsoft
It is the application software developed by database engine and program.
Computer program written with Fox-
The Pro language, developed by researchers, is used to group, sort, and count diagnostic coding in database files.
The final processed data file is imported into Microsoft Excel software for the calculation and graphical representation of the data.
Results during the 1999-2000 period, the common disease group was continuously monitored.
The first two patients with ahnh ed were upper respiratory infections and stomach problems, and there were significant seasonal changes in these disease groups (figs 1 and 2).
As expected, the incidence of upper respiratory tract infection has increased in winter and decreased in summer.
In contrast to summer and winter, the peak of intestinal stomach disease is Shuangfeng.
There are many potential reasons for this, but there are also some customs that may contribute.
Hong Kong people tend to buy food (
Especially cold drinks with ice fries)
Illegal vendors on the street during the summer.
People like to eat hot food in winter.
\"Pot\" dinner made of a pot of boiling soup, the whole family gathered in this heat-pot for dinner.
Raw meat is cooked in a boiled soup for a minute or two.
Sometimes the meat is not cooked thoroughly before eating.
Download figure 1 the attendance rate of AHNH upper respiratory tract infection in the new tabDownload powerpoint.
Average number of upper respiratory infections in 2000.
One SD, one standard deviation more than the average number in 2000.
-1 SD, 1 standard deviation less than the average number in 2000.
Download the new tabDownload figureOpen powerpointFigure month to attend the AHNH.
The average number of stomach diseases in 2000.
One SD, one standard deviation more than the average number in 2000.
-1 SD, 1 standard deviation less than the average number in 2000.
There are several disease groups that appear to be necessary for public health intervention.
It is observed that the number of dog bites has increased in a few months (fig 3).
In Hong Kong, bites are often a secondary cause of stray dogs.
The civil authorities were informed and launched a campaign to round up stray dogs.
After that, the number of dogs bitten was significantly reduced.
The sting is another example of the need to intervene.
The sting of bees has increased in the summer, and our monitoring has alerted the civil authorities.
A campaign was carried out to destroy the extra hive.
The problem is under control (fig 4)
However, there was another spike in the summer of the following year.
Download the attendance of dog bites in figure 3 AHNH in the new tabDownload powerpoint.
The average number of dog bites in 2000.
One SD, one standard deviation more than the average number in 2000.
-1 SD, 1 standard deviation less than the average number in 2000.
Download the attendance of the sting in figure 4 AHNH in the new tabDownload powerpoint.
The average number of bees stabbed in 2000.
One SD, one standard deviation more than the average number in 2000.
-1 SD, 1 standard deviation less than the average number in 2000.
Common infectious diseases such as measles and handfoot-
Oral diseases and chickenpox are also closely monitored.
The incidence of hand increases suddenly-foot-
Oral diseases and chickenpox in 1999 (fig 5)
Germany and Germany in 2000fig 6)
The health authorities and the media were informed.
Awareness-raising and health education by health authorities may help to control the spread of these infectious diseases.
Figure 5 the diagnosis of AHNH infectious diseases in 1999.
Chickenpox and handsfoot-mouth (HFM).
Download figureOpen in the new tabDownload powerpoint figure 6 attendance in Germany in AHNH 2000.
The introduction of new toys can sometimes hurt children.
When scooters became very popular in Hong Kong, our ED reported 24 cases within a month.
Since many children are not properly trained in controlling this device, many of them are playing scooters at the mall, so it is expected that scooters will be injured.
The increase in motorcycle injuries was reported to the local district commission and quickly brought to the attention of the media.
Almost all newspapers and television stations make this a headline. fig 7).
Training classes have been organized to ban the use of scooters in shopping malls.
Download the new tabDownload powerpoint Picture 7 scooter reported by the local newspaper was injured.
Discussion This report describes an audit of computerized logs for public health purposes in the same period, using statistical differences in diagnostic categories to highlight potential intervention targets.
Some concrete examples of these data are given.
Given the time period of the monitoring system, it was not possible to determine whether the intervention was effective or whether the decrease in incidence was due to seasonal factors or other factors.
The approach described here is still in its infancy, but it is a simple, cost-effective approach with obvious potential benefits.
Simple community issues such as dog bites and bee sting are relatively small in terms of overall morbidity and mortality.
However, they do show the potential power of this data.
Due to the impact of lost working days and number of patients on the system, extremely common problems such as stomach and upper respiratory tract infection are very important.
Is it possible to reduce attendance (
And incidence)
These common questions about public health interventions are questionable.
Public health interventions may reduce the twin peaks of stomach problems, including food preparation education and strict compliance by street vendors.
Of course, e-Education monitoring will provide feedback on the usefulness of these interventions.
This intervention was not tested during the study.
The high level of upper respiratory tract infection reflects the low threshold for Hong Kong people to participate in EDs for minor complaints.
In the near future, the greatest impact on these presentations may occur on the presentation of fees charged to ED attendees.
The high prevalence and \"discretionary\" factors of whether patients are really participating in this complaint will make it very difficult to study the effects of influenza vaccination or other initiatives.
There has been extensive discussion on the potential utility of EDs for disease monitoring.
This is mainly focused on injury prevention.
The emergence of computerized logs for attendance at 4, 6-12 ED provides great potential benefits, but this does not seem to have been achieved yet.
Many extensive monitoring systems in the United States, such as the \"emergency ID network\" 14, are separate from the regular data collection of emergency information systems.
The slow implementation of full computer, lack of staff time and EDs training, low quality of computer hardware and software, and large number of patients have led to unreliable data input.
Public health authorities are skeptical about the information available and often insist that the inaccuracies are too large to produce useful data.
As a result, additional data input is usually required from the paid data collector.
In areas where there is no useful information for computerized attendance records, strategies to improve the quality of data entry should be implemented.
These include functional ED software, adequate hardware, inclusion of attendance records in daily work processes, improved efficiency for clinicians, regular data audits and feedback.
All Australian states now have computer attendance records similar to those in Hong Kong.
The same is true of most EDs in the UK.
The quality of the data is variable. after a few months of the event, the centralized collection and collation of the data will occur.
Some states such as Victoria have used this data for injury monitoring and planning of specific interventions.
However, there is no more widespread use of this data for system-wide disease surveillance.
This public health tool is in use.
If ED staff are aware that data entry is monitored and acted upon on a daily basis, they may improve the accuracy of the data.
Currently, ED staff sees this as a management tool that has little benefit to them or their patients in a timely, accurate data entry.
Although it was not fully utilized during this study, due to the common and unique HKID and the Hospital Authority intranet, the ED computer system in Hong Kong also has the ability to track cases across Hong Kong.
Thus, in many hospitals, for example, a sudden rise in respiratory cases may be identified earlier and sources can be tracked.
In disaster management, it is also possible to monitor the location and status of disaster victims --
Disaster management module.
In order not to overload a hospital in a disaster, medical transfer was carried out at the scene of the accident.
That is to say, victims of different severity will be sent to different hospitals for treatment according to hospital capacity.
Wherever the victims go, their data will be merged into a file if they belong to the same disaster Group.
Therefore, a complete set of updated information about all victims in different hospitals can be retrieved, which is very useful for disaster management as a whole.
This report shows that very important public health information can be monitored as long as there is little additional resources.
For all EDs with computerized attendance records, the data collected is regular data.
Extracting information into the standard statistical package allows immediate identification of any significant changes in the pattern of disease.
Public health practitioners should insist on obtaining timely and reliable ED data to assist in public health monitoring.
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