Questions and Answers for ME/Cs

Collecting the Data
Why Medical Examiners/Coroners join DAWN
DAWN LIVE! for MEs
How New DAWN Works in MEs
How to Join DAWN

Collecting the Data

What is a DAWN case?

A DAWN case is any ED visit or death related to recent drug use. The criteria for inclusion in DAWN are intentionally broad and simple, with few exceptions.

What drugs are included in DAWN?

• Illegal drugs of abuse
  
  
• Prescription and over-the-counter medications
  
  
• Dietary supplements
  
  
• Non-pharmaceutical inhalants
  
  
• Alcohol in combination with other drugs (adults and children)
  
  
• Alcohol alone (age < 21).

What types of cases are included in DAWN?

Because the DAWN cases are defined broadly, DAWN captures many different types of drug-related cases.

What types of ED visits are not included in DAWN?

There are only a few exceptions to the DAWN case criteria. A visit is not included in DAWN

• If the patient left the ED without being treated.
  
  
• If the patient consumed a non-pharmaceutical substance but did not inhale it.
  
  
• If the patient has a history of drug use but no current use.
  
  
• If alcohol is the only substance involved and the patient is age 21 or over.
  
  
• If the only documentation of a drug is in toxicology test results.
  
  
• If the drugs listed are not related to the visit (e.g., current medications).
  
  
• If there is no evidence of recent drug use.
  
  
• If the patient is being treated for under medication, i.e., taking too little of a drug.

What types of drug-related deaths are not included in DAWN?

There are only a few exceptions to the DAWN case criteria. A death is not included in DAWN:

• If the death is not reviewed or investigated by a medical examiner or coroner.
  
  
• If the decedent consumed a non-pharmaceutical substance but did not inhale it.
  
  
• If the decedent has a history of drug use but no current use.
  
  
• If alcohol is the only substance involved and the decedent is age 21 or over.
  
  
• If the only documentation of a drug is in toxicology test results.
  
  
• If the drugs listed are not related to the death (e.g., current medications).
  
  
• If there is no evidence of recent drug use.
  
  
• If the drug did not cause or contribute to the death.
  
  
• If the death was due to under-medication, i.e., taking too little of a drug.
  
  
• If the decedent was a homicide victim, even if on drugs at the time of death.

How are DAWN cases found?

DAWN cases are found by a retrospective review of all ED medical records or ME/C case files. Patients or families are never interviewed. The review of source records is performed by a trained DAWN Reporter in each member facility. For each DAWN case found, the DAWN Reporter abstracts DAWN data items from the source record.

The DAWN Reporter submits the DAWN data items electronically through secure, Internet-based systems, which help to maintain the timeliness of the information.

Why is it necessary to review all ED medical records or ME/C case files?

Multiple field studies have shown that alternate methods miss substantial numbers of DAWN cases.

Does DAWN review records of patients who do not come through the ED?

No, DAWN only collects data on ED visits, and only the ED charts are reviewed.

Is it true that DAWN only collects data on illegal drugs?

• Illegal drugs of abuse
  
  
• Prescription and over-the-counter medications
  
  
• Dietary supplements
  
  
• Non-pharmaceutical inhalants
  
  
• Alcohol in combination with other drugs (adults and children)
  
  
• Alcohol alone (age < 21).

How are drug abuse cases denoted in the New DAWN?

New DAWN recognizes it is often difficult to distinguish among cases of drug use, misuse, or abuse in medical records. Also, drug misuse or abuse is often not explicitly or consistently recorded. Therefore, DAWN uses an indirect method to identify drug abuse.

Each case reported to DAWN is assigned to one of eight case types according to the following hierarchy:

Cases not falling into any of the first seven case types are classified as "Other." Most drug abuse cases are classified as "Other."

For analysis, DAWN uses methods to identify different categories of non-medical use, misuse, or abuse. One approach may include combining cases of:

• Other
  
  
• Overmedication.

A more expansive category of drug misuse/abuse might also include

• Malicious poisoning
  
  
• Seeking detox
  
  
• Suicide attempt.

A third approach focuses on the illicit drugs, regardless of case type.

Does DAWN collect current medications unrelated to the visit or death?

No, DAWN Reporters are trained to report only those drugs related to the ED visit or death. If a current medication is unrelated to the visit, it is not reportable.

Why Medical Examiners/Coroners Join DAWN

What's new about the New DAWN?

• The New DAWN is no longer just about drug abuse. DAWN now includes all types of drug-related emergency department (ED) visits and medical examiner- or coroner-reported deaths. This includes visits or deaths related to the following:

  DAWN ED cases include:	DAWN mortality cases include:
  Drug abuse and misuse Suicide attempts Overmedication Adverse reactions Accidental ingestions Malicious poisoning Underage drinking Patients seeking detoxification or drug abuse treatment	Drug abuse and misuse Completed suicides Overmedication Adverse reactions Accidental ingestions Homicide by drugs Underage drinking Other deaths related to drugs

  
  This expanded coverage makes the system more useful to hospitals, medical examiners or coroners (ME/Cs), and other users of DAWN data.

• DAWN LIVE! a new benefit for members, is an interactive, Web-based system designed to give EDs and ME/Cs access to their own data in "real" time. DAWN LIVE! gives staff the ability to track the patterns of drug-related cases and deaths seen, the drugs involved, and the patients/decedents affected. This kind of information can help hospitals manage resources and staffing to respond to changing caseloads, and ME/Cs to identify serious drug-related threats to the public health.
  
  
• Metropolitan areas updated in New DAWN to reflect the 2000 Census.

What are the benefits of joining DAWN?

DAWN provides training, technical support, payment for participation, and real-time access to each member’s own data. DAWN helps EDs and ME/Cs monitor the patterns of drug-related cases seen, recognize sentinel events, and increase staff awareness of drug-related cases. This kind of information can help hospitals manage resources and staffing to respond to changing caseloads, and ME/Cs to identify serious drug-related threats to the public health.

With DAWN LIVE!—the Internet-based system for using the facility’s data—hospital staff are beginning to demonstrate the need for specialized services, such as psychiatric or detoxification units, for better and less costly patient care.

Clinicians in some participating hospitals use DAWN data regularly in preparing grant proposals. Others use DAWN data as evidence of the hospital’s contribution to the public health of its community.

Is participation in DAWN mandatory?

DAWN is mandatory for SAMHSA but voluntary for hospitals and ME/Cs

How was our jurisdiction chosen to be in DAWN?

ME/Cs are invited to join DAWN based on their location in selected metropolitan areas.

In addition, DAWN has been adding States with centralized medical examiner systems to gain a better understanding of drug-related mortality outside of the targeted metropolitan areas.

My jurisdiction has very few drug-related cases. How can that be useful to DAWN?

DAWN needs the participation of every jurisdiction in targeted metropolitan areas and States. All jurisdictions make it possible to understand mortality due to drugs for that entire metropolitan area or State. If some jurisdictions do not participate, DAWN won’t know what might be missing.

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DAWN LIVE! for ME/Cs

What is DAWN LIVE!

DAWN LIVE! is a secure, Internet-based query system that gives DAWN members access to the data submitted for their facility. Authorized staff named by their facility may use DAWN LIVE!. All data in DAWN LIVE! are de-identified.

I don't have a lot of time. How easy is it to use?

DAWN LIVE! is accessed via the Internet. Authorized users go to the DAWN LIVE! website and log in with their user name and password and agree to use the data within the confidentiality restrictions required.

The DAWN LIVE! search page is very simple. With just a few clicks of a mouse, users choose the types of drug-related cases, drugs of interest, time periods, and other characteristics of DAWN cases to tabulate. Drugs may be chosen or tabulated down to the brand level. Simple instructions are provided on the screen.

Who can use it? How do I get a password?

Staff must be designated by participating facilities to access DAWN LIVE! Initially, each DAWN facility designates in their participation agreement the staff members who can use DAWN LIVE! Additional staff can be added by the facility administrator at any time. Westat assigns passwords once authorizations are received.

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How New DAWN Works in ME/Cs

What are the Reporter options?

DAWN makes reporting as easy as possible with a number of options:

1. Westat Field Reporter. Westat can provide a person to collect data in your facility. This option offers a lot of flexibility in terms of the days or shifts when the data are collected.
   
   
2. ME/C After-Hours Reporter. Your facility can recommend a staff member to collect DAWN data during his or her off-duty hours.
   
   
3. ME/C Staff Reporter. Your staff collect the data as part of their regular duties during the normal workday.

Does the Reporter need office space?

Some space is necessary. Westat will work with you to find the best approach for your facility. For example, a Westat Field Reporter could come during an evening shift if that is when space is available. If there is no room to use a facility computer, we can provide a laptop computer, which requires less space.

Our goal is to find the approach that works best for you. We don’t want to change the way you do business.

How are the data submitted to DAWN?

All data are submitted electronically.

For EDs, most data are submitted using eHERS (electronic Hospital Emergency Reporting System).

• eHERS is a secure, Internet-based data entry system.
  
  
• If Internet access is not available at the data collection point, data are entered into a standalone version of eHERS on a laptop computer, and then are uploaded to the central database later.

For ME/Cs, most data are submitted using eMERS (electronic Medical Examiner Reporting System).

• eMERS is a secure, Internet-based data entry system.
  
  
• If Internet access is not available at the data collection point, data are entered into a standalone version of eMERS on a laptop computer, and then are uploaded to the central database later.

How frequently are data submitted to DAWN?

DAWN is a continuous data collection system. We do not sample patients, visits, or time periods.

Timeliness of the data is very important. For DAWN to be a "warning" network, the data must be timely. For DAWN data to be useful in real-time, the data must be timely. What does this mean?

• For EDs, cases should always be submitted within 30 days, but we prefer to have cases submitted within one week of ED visits.
  
  
• It often takes longer for ME/Cs to close out cases, so they cannot be submitted to DAWN this quickly.

What are the payment options for ME/Cs?

The payments are designed to be equitable across jurisdictions.

Payments for Statewide systems differentiate between States with targeted metropolitan areas and those without.

What kind of assistance can we expect from SAMHSA or Westat?

Here is what we do to assist you in participating in DAWN:

What type of equipment do we have to provide?

Your DAWN Reporter will use a computer workstation with Internet access provided by your facility. If you do not have a workstation or Internet access available for DAWN, Westat will provide all necessary equipment or Internet connections.

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How to Join DAWN

Whom do I contact to discuss joining DAWN?

For information on joining DAWN, please call 800-FYI-DAWN and ask for Facility Relations. Facility Relations staff are trained to answer all your questions about joining DAWN.

Who should sign the participation agreement in our facility?

Any individual who has the authority to sign hospital agreements or contracts can sign the DAWN participation agreement. These individuals include CEOs, ED Directors or Administrators, or Chief Nursing Officers. For MEs, it is usually the Chief Medical Examiner or Office Administrator.