What's the ER doc's role in epidemiology?

[TheTruckGuy]

Have any of y'all thought about this? For example, if someone comes into the ED with flu like symptoms, in the middle of flu season, and is an otherwise young and healthy individuals, I see no utility in testing for the flu (I'm also not a fan of Tamiflu for non-high risk populations), so it's usually just r/o something like a pneumonia, reassurance, doctor's note, and OTC symptom control.

But with these periodic outbreaks of things like SARS, MERS, this novel corona virus, or even failed treatments of things like CAP or STDs, what role should we play in ensuring population health threats are identified early?

Let's say in the case of a new, very virulent, strain of the flu, what can we even do if we wanted to do something? Even if we do a rapid flu, it's not like our labs are going to sequence the DNA and look for a novel strain.

Before this post turns into more word salad, what are y'all's thoughts on the matter?

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[Tenk]

We play the role of the disposable canary guinea pigs.

 

[RustedFox]

What's a epidemiology?

 

[deleted109597]

We play the role of the disposable canary guinea pigs.

Yep.
We aren't allowed to miss anything, especially not a case of Ebola or anything similar.
But our tests will never be 100% accurate. Even if we flu swabbed everyone, there are enough false negatives that we would bankrupt the country doing secondary screening for other things.
I'm really not looking forward to dengue making it's way up from the tropics.

 

[Porfirio]

Patient: *sniffle and drip from nose*
Me: Have you traveled to Wuhan China within the past month?

 

[Tenk]

What's a epidemiology?

It’s the thing Dustin Hoffman studied in the movie Outbreak that somehow gave him the power to cure the virus by finding the first infected monkey and extracting their magical juju power.

 

[TooMuchResearch]

I've admitted two ill influenza A patients after negative clinic antigen testing so far this year.

Yep.
We aren't allowed to miss anything, especially not a case of Ebola or anything similar.
But our tests will never be 100% accurate. Even if we flu swabbed everyone, there are enough false negatives that we would bankrupt the country doing secondary screening for other things.
I'm really not looking forward to dengue making it's way up from the tropics.

 

[TooMuchResearch]

I'll leave it to the hospital systems to screen this stuff, then I'll ask pertinent questions on those who screen positive.

Patient: *sniffle and drip from nose*
Me: Have you traveled to Wuhan China within the past month?

 

[TooMuchResearch]

I don't want to ruin it for anyone, but Kevin Spacey died from a lack of orange juice.

It’s the thing Dustin Hoffman studied in the movie Outbreak that somehow gave him the power to cure the virus by finding the first infected monkey and extracting their magical juju power.

 

[GeneralVeers]

I usually order an ultrasound. It's the thing on the back of the testes that's inflamed.

 

[Goro]

Yep.
We aren't allowed to miss anything, especially not a case of Ebola or anything similar.
But our tests will never be 100% accurate. Even if we flu swabbed everyone, there are enough false negatives that we would bankrupt the country doing secondary screening for other things.
I'm really not looking forward to dengue making it's way up from the tropics.

My Microbiology colleague worries about all the bugs carried by Anopheles and Aedes mosquitoes.

 

[thegenius]

I think you practice your own brand of medicine, and to whatever extent you end up with epidemiological data for public health, then thats what they get.

I would not order a test purely for public health screening unless 1) public health pays for it, 2) the patient consents, and 3) it will make a difference in treatment.

For example, a young healthy woman comes in with uncomplicated dysuria. This is like hr previous UTIs. I will just give her antibiotics and not even bother with a UA or urine culture. It’s acceptable medical care but not helpful for epidemiology or public health.

 

[wholeheartedly]

So I have a clinical lab background, grad degree in epi, and am doing infection prevention in a hospital at the moment, so I have a bit of experience with this stuff.

My perspective is that there's a lot going on behind the scenes taking care of this public health type stuff already. For example, I report all of our STDs and treatments to the health department and they contact those patients, notify partners, and monitor for treatment failures and resistance.

There are mandatory reporting requirements for each state and while most places are set up to have the EMR electronically transmit positive lab results, there are other things that need to be reported immediately before results such as measles, MERs, SARS, Ebola, etc. In my facility I report everything that's not immediately reportable, the doc reports those. Then I would help coordinate the ensuing goat rodeo so they could focus on patient care.

If you suspect novel or highly virulent influenza the health depatment here will do the more extensive testing for free. If you're questioning your facility's flu testing is off that year, our health department can help check it out. Our lab also sends a certain number of influenza samples each week to the health department for them to do more in depth testing on (this is free to the patient and us), so I don't care if you don't test everyone. West Nile Virus testing is free from the health dept in the summer.

Generally in my state, if a sample gets sent to the health department for their epidemiological purposes they don't charge the patient. If we're having them run a test for us to treat and diagnose with them functioning as a reference lab, then they bill for it but usually much less than anywhere else.

I spend quite a bit of time doing surveillance on many things in my facility and collaborating with the health department pretty regularly so you all can focus on patient care. What I do expect is for you to keep an eye out for the really bad things, the immediately reportable things and notify the infection prevention dept and health department ASAP so we can get a jump on dealing with it before it gets out of hand.