BACKGROUND: New Hampshire (NH) has experienced a significant increase in opioid-related overdoses and deaths in recent years; similar increases have been observed across the United States. We describe the methods used to collect and analyze emergency department (ED) data to monitor opioid-related overdoses and their use in the overall public health response to this health problem.
METHODS: NH’s ED data system, which includes data from 25 of 26 acute care hospitals in NH, was queried to identify opioid-related encounters from 2011 - 2015. Chief complaint text was queried for words related to fentanyl, heroin, opiate, and opioids. Opioid-related International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes were also queried for opioid-related codes. Data were analyzed to calculate frequencies for key demographic characteristics.
RESULTS: From 2011 through 2015, data for 3,101,402 ED encounters were collected. Opioid-related encounters increased by 70% from 3,300 in 2011 to 5,603 in 2015 for a total of 20,994 encounters during the time period. Of these, 18,556 (89%) encounters were identified by ICD code alone, 690 (3%) encounters were identified by chief complaint text alone, and 1,750 (8%) encounters were identified by both chief complaint text and ICD code. For those encounters identified by ICD code only, the corresponding chief complaint text included varied and non-specific words, with the most common being “pain” (n= 3335, 18%), “overdose” (n= 1555, 8%), “suicidal” (n= 816, 4%), “drug” (n= 803, 4%), and “detox” (n= 750, 4%). Heroin-specific encounters increased by 827% from 4% of opioid-related encounters in 2011 to 24% of encounters in 2015. Regarding demographic characteristics, we found that the largest increases in opioid-related ED encounters were occurring in individuals aged 18 to 29 years, and in males. Data were aggregated and shared with public health partners.
CONCLUSIONS: Opioid-related ED encounters have increased significantly in recent years. NH’s robust ED data system was used to provide timely situational awareness to partners to support the overall response to this public health issue. The ED data system also helped to define demographic and geographic impact and local agencies reported using the data to help support requests for additional resources and to target limited resources in their area. While certain limitations exist with use of ED data, these data present one of the most robust, complete, and flexible sources of timely data for monitoring current health problems in a population.