Towards public health surveillance of intensive care services in NSW, Australia.

Abstract

Outbreaks of known and novel pathogens causing very severe illness increase the risk to public health in a globalised community and alarm the public. Intensive care units (ICUs) may be an underused setting for public health surveillance. This study investigates the electronic Record for Intensive Care (eRIC), an electronic clinical information and management system being developed for New South Wales ICUs, and its surveillance opportunity offerings. The surveillance benefits being introduced by the eRIC were evaluated through consultation with stakeholders and the eRIC program team. The consultation process involved providing stakeholders with background information about the eRIC system. Based on the consultation, a draft data and information model for surveillance was developed. The model was evaluated using guidelines from the US Centers for Disease Control and Prevention. Population health stakeholders confirmed that the eRIC offers an appealing surveillance data source for pathogens and other hazards causing severe illness. Suggested application of the surveillance included, for known hazards, seasonal and pandemic influenza, enterovirus 71, Murray Valley encephalitis virus, enterohaemorrhagic Escherichia coli 0104:H4 and parechovirus. The proposed surveillance model uses syndromic rather than specific-cause surveillance. It may offer greater timeliness and sensitivity than relying on reporting of diagnoses of specific pathogens. Five syndromes derived from clinical pathways in the eRIC are proposed: severe acute respiratory disease, severe acute neurological disease, sepsis or septicaemia, jaundice or hepatitis, and acute renal failure. New intensive care clinical information systems offer a largely untapped resource for continuous, mainstream, rapid ICU surveillance of severe illness. A continuous, mainstream, rapid ICU surveillance facility that will readily adapt to emergency situations would be a valuable resource for protecting population health. This study establishes a firm basis on which ICU surveillance can be developed.