About Emergency Department Data

Current Activities

The final year of data from the Drug Abuse Warning Network was 2011. Between 2011 and 2016, SAMHSA will continue to analyze and report using DAWN data. To replace DAWN, CBHSQ has been working with the National Center on Health Statistics on its new National Hospital Care Survey (NCHS). Through this new survey, SAMHSA will receive data on drug-related emergency department (ED) visits and will publish them as SAMHSA’s Emergency Department Surveillance System (SEDSS).

Future

The National Center for Health Statistics (NCHS) is currently implementing a redesign of its hospital data collection systems, including its Emergency Department (ED) component. This new endeavor, called the National Hospital Care Survey (NHCS), combines the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Hospital Discharge Survey (NHDS) as well as DAWN that was collected by SAMHSA. The advantages include an improved response rate with a large, nationally representative sample of hospital EDs, reduction in cost, expanded information that will be collected (e.g., health insurance coverage information, diagnoses, treatment, and ability to track ED patients who have been admitted into the hospital through the ED). In addition, the NHCS will collect robust and comprehensive data on mental health-related ED visits. Under the redesign, SAMHSA will receive data on drug-related visits as well as mental health related visits. Information on clinical history, patient conditions, procedures done, health insurance coverage, and more detailed disposition and provider information will also be available. Currently, NCHS is working to recruit hospitals with publishable data expected in the near future. Under this new data collection effort, SAMHSA will publish drug- and mental health-related visit data as SAMHSA’s Emergency Department Surveillance System or SEDSS.

History of DAWN

The Drug Abuse Warning Network (DAWN) was established in 1972 by the Drug Enforcement Administration (DEA) to track emergency department (ED) visits caused by drug abuse in order to identify the drugs being abused, determine patterns in selected metropolitan areas and changing trends across the country, including the detection of new substances of abuse and new combinations. Initially focusing on metropolitan areas only, the system was later expanded to produce estimates for the U.S. and to capture deaths drug abuse-related deaths investigated by medical examiners/coroners in selected metropolitan areas. DAWN was transferred to the U.S. Department of Health and Human Services (DHHS) in 1980, where it was conducted by the National Institute on Drug Abuse (NIDA) within the National Institutes of Health (NIH). When NIDA assumed responsibility for DAWN, implementation of a sample of hospitals to produce representative estimates for the Nation and for selected metropolitan areas became a priority. In 1992, the Substance Abuse and Mental Health Services Administration (SAMHSA) took responsibility for DAWN and through 2011, the Center for Behavioral Health Statistics and Quality (CBHSQ, formerly the Office of Applied Studies) was responsible for DAWN operations and reporting. DAWN continued to produce estimates of drug abuse-related emergency department visits for the contiguous United States and 21 metropolitan areas through 2002. Because there were population shifts and changes in the hospital industry, DAWN implemented a sample redesign in 2003. Many other features of DAWN (e.g., redefining a DAWN visit to include all drug-related medical emergencies and not merely those involving misuse or abuse; the introduction of estimates that were representative of the Nation; changes in case-finding methodology etc.) were also introduced at that time. The medical examiner/coroner component of DAWN continued to collect data on drug-related deaths through 2010. Although the data were never nationally representative, by its final year in 2011, DAWN collected data from metropolitan areas in 37 States (with complete coverage of 13 States) and covered one-third of the U.S. population.

DAWN Methodology

DAWN's target population consists of all non-Federal, short-stay, general medical and surgical hospitals in the United States that have one or more EDs open 24 hours a day. The design consists of a stratified two-stage cluster sample of emergency department (ED) visits within hospitals. At the first stage, a stratified simple random sample without replacement of hospitals meeting the criteria for inclusion in the target population was drawn from the American Hospital Association’s 2001 Annual Survey Database of hospitals meeting the criteria for inclusion in the target population. This sample was supplemented with additional sample units in selected metropolitan areas to allow for separate estimates in those areas. The design initially called for review of all ED visits within the sampled hospitals and abstraction of all visits deemed substance-involved. Sampling at the second (visit) stage was implemented beginning in 2009 for hospitals with the largest numbers of total ED visits in order to meet resource constraints. In order to make population estimates, a set of final weights is applied to the visit observations. These weights are the product of the design weight for each hospital, factors to account for within-hospital monthly nonresponse and hospital-level nonresponse, and a ratio adjustment for observed versus frame total numbers of ED visits. More information may be found at www.samhsa.gov/data/sites/default/files/DAWN2k10/DAWN2k10/DAWN2k10-Methods-Report.htm