Country Update on Injury Surveillance: Malta

Country update on Injury Surveillance: Malta.

Introduction

TheMaltesearchipelagoliesvirtuallyat the centeroftheMediterraneanjust93kmsouth ofSicilyand288kmnorthofAfrica.The archipelagoconsistsofthreeislands:Malta, GozoandCominowithatotalpopulationof justover400,000inhabitantsoveranareaof316sqkmanda coastlineof197 km (notincluding56kmfortheislandof Gozo)makingMaltaoneofthemost denselypopulatedcountries.

TheDepartmentofHealthhaslongfeltthe needforinjurysurveillance.Themain impetuscamefromtwosources.

Firstly,our mortalityrecordsshowthatfallsarestilla substantialunderlyingcauseofdeathinthe Malteseelderly.TheInjurydatabasecan provideaninsightintosuchinjuries– particularlythenon-fatalones,withaviewtodesignpoliciesandfacilitatemeasuresto reducethiscauseofmorbidity.Secondly,theMaltaStandardsAuthorityhasbeen seekingtocollaboratewiththeDepartment ofHealthontheissueofproductsafety surveillance,sothatdatawouldbeavailableoninjuriesrelatedtotheuseof consumerproductsorservices.

Dataon injuriestreatedinEmergencyDepartments provideinvaluableinformationonthecircumstancesandcausesofproductrelated injuriesandassistenforcementofficersin theirriskassessmentprocedures.

Malta’s Health Care System

Maltahasalonghistoryofprovidingpubliclyfundedhealthcareknownasthegovernmenthealthcareservice,wherehealthcareisfreeatthepointofdelivery,inparalleltoa privatehealthcaresystem.Primarycareis predominantlybeingprovidedinsoloprivategeneralpractices(60%)andinthe publicdistricthealthcenters(40%).Public hospitalsprovidemostofthesecondary

andtertiarycare.

Therearetwopublicgeneralhospitalsin Malta.MaterDeiHospital,inauguratedin November2009,isMalta'sprimaryhospital, andoneofthelargest,mostmodernand wellequippedmedicalcentersinEurope.GozoGeneralHospital(GGH)istheothergovernmenthospital locatedontheislandofGozo.

Data from emergency departments

TheInjuryDataBasewasofficiallylaunched inMaltainSeptember2004.TheDepartment ofHealthInformationandResearch(DHIR)isthebodyresponsibleforthecompilationof suchdata.

DatacollectionsstartedatGGH, usingaspecificformforMaltawhichincludedtheminimumdatasetofinformation inlinewiththeEU-IDB.Thiswasdesignedin suchawaysoastofacilitatethecompletion oftheformbytriagenursesordoctors, throughminimisationoffree-textandusing mainlytick-boxes,torendertheinformation clearerandalsoreducetheworkloadofthe nurse/doctorasmuchaspossible.After completion,theformsareforwardedtoDHIR onamonthlybasiswheretheyarecoded againsttheIDBCodingManualData Dictionaryandtheninputtedinthemain databaseatDHIR.

TheMaterDeiHospital(MDH)hasbeenincludedinthesystemonlyrecently.Thisrequiredustodevelopanelectronicsolution fordataprocessinginthehospital,asthe patientregisterinthathospitalwasalready quiteadvancedandtheuseofstand-alone paperformswouldhavegeneratedan excessiveburdenfortheemergencydepartmentpersonnel.Thishospitalhandles anaverageof tenthousandepisodesper month.

A dataminingsoftwarewasdevelopedto capturedatafromhospitalrecords.The softwaremakesusebothofexistingfieldsin thepatientrecords,particularlythe demographicvariables,andalsoofafree-text fieldinwhichashortdescriptionofthe episodeistypicallyenteredbythetriage nurse.

Thisprocesshelpsnotonlyinfiltering injuryepisodesbutalsoinpre-populatinga numberofvariablesforeachepisode.The softwareiscapableofidentifyingacronyms/ terms/phrases/wordstoextractinjuryepisodes.Relevantvariablestakenforeach episodeincludeanatomicalsite,injurytype and objectsinvolved.

DatacollectionatMDHstartedinJanuary2012andDHIRstaff arecurrentlyvisiting theAE personnelforshorttrainingand reachoutsessions. DataiskeptinaccordancewiththeData ProtectionAct,2001.Thisallowsan effectivecross-linkwithhospitaldischarge registersandnationalmortalityregisterin ordertoavoidduplications,toverifylengthofstayanddeath-relatedinjuriesanddetect injuriesbypassingemergencydepartments. A veryhighproportionofincidentslackdataregarding placeofoccurrence,activityandobjects involved.

Data use

TheInjuryDatabaseisbeingconsultedfor numerousad-hocspecificrequestsin responsetopolicyorproductsafety queries.Informationgeneratedfromthe Databaseisdisseminatedbothviaregular reportsandpublications,andthroughcommunicationsinavarietyoffora.

For more information:

audrey.gal