Vulnerability of Older Adults in Disasters: Emergency Department Utilization by Geriatric Patients After Hurricane Sandy

2017 ◽  
Vol 12 (2) ◽  
pp. 184-193 ◽  
Author(s):  
Sidrah Malik ◽  
David C. Lee ◽  
Kelly M. Doran ◽  
Corita R. Grudzen ◽  
Justin Worthing ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
New York ◽  
Natural Disaster ◽  
Care Delivery ◽  
Hurricane Sandy ◽  
Emergency Department Utilization ◽  
Electrolyte Disorders ◽  
Ed Visits ◽  
The Impact

ABSTRACTObjectiveOlder adults are a potentially medically vulnerable population with increased mortality rates during and after disasters. To evaluate the impact of a natural disaster on this population, we performed a temporal and geospatial analysis of emergency department (ED) use by adults aged 65 years and older in New York City (NYC) following Hurricane Sandy’s landfall.MethodsWe used an all-payer claims database to analyze demographics, insurance status, geographic distribution, and health conditions for post-disaster ED visits among older adults. We compared ED patterns of use in the weeks before and after Hurricane Sandy throughout NYC and the most afflicted evacuation zones.ResultsWe found significant increases in ED utilization by older adults (and disproportionately higher in those aged ≥85 years) in the 3 weeks after Hurricane Sandy, especially in NYC evacuation zone one. Primary diagnoses with notable increases included dialysis, electrolyte disorders, and prescription refills. Secondary diagnoses highlighted homelessness and care access issues.ConclusionsOlder adults display heightened risk for worse health outcomes with increased ED visits after a disaster. Our findings suggest the need for dedicated resources and planning for older adults following a natural disaster by ensuring access to medical facilities, prescriptions, dialysis, and safe housing and by optimizing health care delivery needs to reduce the burden of chronic disease. (Disaster Med Public Health Preparedness. 2018;12:184–193)

scholarly journals Temporal and Spatial Patterns in Utilization of Mental Health Services During and After Hurricane Sandy: Emergency Department and Inpatient Hospitalizations in New York City

2016 ◽  
Vol 10 (3) ◽  
pp. 512-517 ◽  
Author(s):  
Fangtao Tony He ◽  
Nneka Lundy De La Cruz ◽  
Donald Olson ◽  
Sungwoo Lim ◽  
Amber Levanon Seligson ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
New York ◽  
New York City ◽  
York City ◽  
Hurricane Sandy ◽  
Service Areas ◽  
Health Related ◽  
Ed Visits ◽  
The Impact

AbstractObjectiveHurricane Sandy made landfall on October 29, 2012, causing a coastal storm surge and extensive flooding, which led to the closure of several health care facilities in New York City (NYC) and prolonged interruptions in service delivery. The impact on mental health–related emergency department (ED) and inpatient hospital service utilization was studied.MethodsData came from the New York Statewide Planning and Research Cooperative System. We obtained mental health–related data among NYC residents from 2010 to 2013. Patients were grouped into 5 geographic areas, including service areas of closed hospitals, the Hurricane Sandy evaluation zone, and all of NYC. The Farrington method was used to detect increases in ED visits and hospitalizations for the post-Sandy period.ResultsOpen hospitals experienced a substantial increase in psychiatric ED visits from patients living in the service areas of closed hospitals. This surge in psychiatric ED visits persisted for 4 to 6 months after Hurricane Sandy. However, the increase in psychiatric hospitalizations was observed for 1 to 3 months.ConclusionsSeveral NYC hospitals received a substantially larger number of ED patients from service areas of closed hospitals after Hurricane Sandy, unlike other hospitals that experienced a decrease. Because of potential surges in the number of psychiatric ED visits, resource allocation to hospitals should be considered. (Disaster Med Public Health Preparedness. 2016;10:512–517)

Effects of Hurricanes on Emergency Department Utilization: An Analysis Across 7 US Storms

2020 ◽  
pp. 1-8
Author(s):  
Kevin C Heslin ◽  
Marguerite L Barrett ◽  
Molly Hensche ◽  
Gary Pickens ◽  
Jeanne S Ringel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Preparedness ◽  
Emergency Department Utilization ◽  
Disease Category ◽  
Preparedness Planning ◽  
Emergency Managers ◽  
Planning Processes ◽  
Ed Visits ◽  
The Impact ◽  
Population Rate

ABSTRACT Objective: Emergency departments (EDs) are critical sources of care after natural disasters such as hurricanes. Understanding the impact on ED utilization by subpopulation and proximity to the hurricane’s path can inform emergency preparedness planning. This study examines changes in ED utilization for residents of 344 counties after the occurrence of 7 US hurricanes between 2005 and 2016. Methods: This retrospective observational study used ED data from the Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases. ED utilization rates for weeks during and after hurricanes were compared with pre-hurricane rates, stratified by the proximity of the patient county to the hurricane path, age, and disease category. Results: The overall population rate of weekly ED visits changed little post-hurricane, but rates by disease categories and age demonstrated varying results. Utilization rates for respiratory disorders exhibited the largest post-hurricane increase, particularly 2–3 weeks following the hurricane. The change in population rates by disease categories and age tended to be larger for people residing in counties closer to the hurricane path. Conclusions: Changes in ED utilization following hurricanes depend on disease categories, age, and proximity to the hurricane path. Emergency managers could incorporate these factors into their planning processes.

scholarly journals P035: Impact of EMS direct referral to community care on emergency department utilization

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S75
Author(s):  
A. Dukelow ◽  
M. Lewell ◽  
J. Loosley ◽  
S. Pancino ◽  
K. Van Aarsen
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Community Care ◽  
Home Care Services ◽  
Emergency Department Visits ◽  
Emergency Department Utilization ◽  
Care Services ◽  
Significant Difference ◽  
Ed Visits ◽  
The Impact

Introduction: The Community Referral by Emergency Medical Services (CREMS) program was implemented in January 2015 in Southwestern Ontario. The program allows Paramedics interacting with a patient to directly refer those in need of home care support to their local Community Care Access Centre (CCAC) for needs assessment. If indicated, subsequent referrals are made to specific services (e.g. nursing, physiotherapy and geriatrics) by CCAC. Ideally, CREMS connects patients with appropriate, timely care, supporting individual needs. Previous literature has indicated CREMS results in an increase of home care services provided to patients. Methods: The primary objective of this project is to evaluate the impact of the CREMS program on Emergency Department utilization. Data for all CCAC referrals from London-Middlesex EMS was collected for a thirteen month period (February 2015-February 2016). For all patients receiving a new or increased service from CCAC the number of Emergency Department visits 2 years before referral and 2 years after referral were calculated. A related samples Wilcoxon Signed Rank Test was performed to examine the difference in ED visits pre and post referral to CCAC. Results: There were 213 individuals who received a new or increased service during the study timeframe. Median [IQR] patient age was 77 [70-85.5]. 113/213 (53%) of patients were female. The majority of patients 135/213 (63.4%) were a new referral to CCAC. The median [IQR] number of hospital visits before referral was 3 [1-5] and after referral was 2 [0-4]. There was no significant difference in the overall number of ED visits before versus after referral (955 vs 756 visits, p = 0.051). Conclusion: Community based care can improve patient experience and health outcomes. Paramedics are in a unique position to assess patients in their home to determine who might benefit from home care services. CREMS referrals for this patient group showed a trend towards decreased ED visits after referral but the trend was not statistically significant.

scholarly journals NYU-EDA in modelling the effect of COVID-19 on patient volumes in a Finnish emergency department

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jalmari Tuominen ◽  
Ville Hällberg ◽  
Niku Oksala ◽  
Ari Palomäki ◽  
Timo Lukkarinen ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Care Hospital ◽  
New York University ◽  
State Of Emergency ◽  
National State ◽  
Point Reduction ◽  
Ed Visits ◽  
Novel Coronavirus ◽  
The Impact

Abstract Background Emergency departments (EDs) worldwide have been in the epicentre of the novel coronavirus disease (COVID-19). However, the impact of the pandemic and national emergency measures on the number of non-COVID-19 presentations and the assessed acuity of those presentations remain uncertain. Methods We acquired a retrospective cohort containing all ED visits in a Finnish secondary care hospital during years 2018, 2019 and 2020. We compared the number of presentations in 2020 during the national state of emergency, i.e. from March 16 to June 11, with numbers from 2018 and 2019. Presentations were stratified using localized New York University Emergency Department Algorithm (NYU-EDA) to evaluate changes in presentations with different acuity levels. Results A total of 27,526 presentations were observed. Compared to previous two years, total daily presentations were reduced by 23% (from 113 to 87, p < .001). In NYU-EDA classes, Non-Emergent visits were reduced the most by 42% (from 18 to 10, p < .001). Emergent presentations were reduced by 19 to 28% depending on the subgroup (p < .001). Number of injuries were reduced by 25% (from 27 to 20, p < .001). The NYU-EDA distribution changed statistically significantly with 4% point reduction in Non-Emergent visits (from 16 to 12%, p < .001) and 0.9% point increase in Alcohol-related visits (from 1.6 to 2.5%, p < .001). Conclusions We observed a significant reduction in total ED visits in the course of national state of emergency. Presentations were reduced in most of the NYU-EDA groups irrespective of the assessed acuity. A compensatory increase in presentations was not observed in the course of the 3 month lockdown. This implies either reduction in overall morbidity caused by decreased societal activity or widespread unwillingness to seek required medical advice.

scholarly journals Impact of Extremely Hot Days on Emergency Department Visits for Cardiovascular Disease among Older Adults in New York State

2019 ◽  
Vol 16 (12) ◽  
pp. 2119 ◽  
Author(s):  
Mengxuan Li ◽  
Benjamin A. Shaw ◽  
Wangjian Zhang ◽  
Elizabeth Vásquez ◽  
Shao Lin
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
New York ◽  
New York State ◽  
Emergency Department Visits ◽  
York State ◽  
Mean Temperature ◽  
Increased Risk ◽  
Hot Days ◽  
Ed Visits

Prior studies have reported the impact of ambient heat exposure on heat-related illnesses and mortality in summer, but few have assessed its effect on cardiovascular diseases (CVD) morbidity, and the association difference by demographics and season. This study examined how extremely hot days affected CVD-related emergency department (ED) visits among older adults from 2005–2013 in New York State. A time-stratified case-crossover design was used to assess the heat–CVD association in summer and transitional months (April–May and September–October). Daily mean temperature >95th percentile of regional monthly mean temperature was defined as an extremely hot day. Extremely hot days were found to be significantly associated with increased risk of CVD-related ED visits at lag day 5 (OR: 1.02, 95% CI: 1.01–1.04) and lag day 6 (OR: 1.01, 95% CI: 1.00–1.03) among older adults in summer after controlling for PM2.5 concentration, relative humidity, and barometric pressure. Specifically, there was a 7% increased risk of ischemic heart disease on the day of extreme heat, and increased risks of hypertension (4%) and cardiac dysrhythmias (6%) occurred on lag days 5 and 6, respectively. We also observed large geographic variations in the heat–CVD associations.

Hurricane Sandy: Impact on Emergency Department and Hospital Utilization by Older Adults in Lower Manhattan, New York (USA)

2015 ◽  
Vol 30 (5) ◽  
pp. 496-502 ◽  
Author(s):  
Hiroshi Gotanda ◽  
Joyce Fogel ◽  
Gregg Husk ◽  
Jeffrey M. Levine ◽  
Monte Peterson ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Geriatric Patients ◽  
Hurricane Sandy ◽  
Hospital Utilization ◽  
Age Group ◽  
Geriatric Population ◽  
Absolute Increase ◽  
Lower Manhattan ◽  
Ed Visits

AbstractBackgroundOn October 29th, 2012, Hurricane Sandy caused a storm surge interrupting electricity with disruption to Manhattan’s (New York, USA) health care infrastructure. Beth Israel Medical Center (BIMC) was the only fully functioning major hospital in lower Manhattan during and after Hurricane Sandy. The impact on emergency department (ED) and hospital use by geriatric patients in lower Manhattan was studied.MethodsThe trends of ED visits and hospitalizations in the immediate post-Sandy phase (IPS) during the actual blackout (October 29 through November 4, 2012), and the extended post-Sandy phase (EPS), when neighboring hospitals were still incapacitated (November 5, 2012 through February 10, 2013), were analyzed with baseline. The analysis was broken down by age groups (18-64, 65-79, and 80+ years old) and included the reasons for ED visits and admissions.ResultsDuring the IPS, there was a significant increase in geriatric visits (from 11% to 16.5% in the 65-79 age group, and from 6.5% to 13% in the 80+ age group) as well as in hospitalizations (from 22.7% to 25.2% in the 65-79 age group, and from 17.6% to 33.8% in the 80+ age group). However, these proportions returned to baseline during the EPS. The proportions of the categories “dialysis,” “respiratory device,” “social,” and “syncope” in geriatric patients in ED visits were significantly higher than younger patients. The increases of the categories “medication,” “dialysis,” “respiratory device,” and “social” represented two-thirds of absolute increase in both ED visits and admissions for the 65-79 age group, and half of the absolute increase in ED visits for the 80+ age group. The categories “social” and “respiratory device” peaked one day after the disaster, “dialysis” peaked two days after, and “medication” peaked three days after in ED visit analysis.ConclusionsThere was a disproportionate increase in ED visits and hospitalizations in the geriatric population compared with the younger population during the IPS. The primary factor of the disproportionate impact on the geriatric population appears to be from indirect effects of the hurricane, mainly due to the subsequent power outages, such as “dialysis,” “respiratory device,” and “social.” Further investigation by chart review may provide more insights to better aid with future disaster preparedness.GotandaH, FogelJ, HuskG, LevineJM, PetersonM, BaumlinK, HabbousheJ. Hurricane Sandy: impact on emergency department and hospital utilization by older adults in Lower Manhattan, New York (USA). Prehosp Disaster Med. 2015;30(5):496–502.

Rebuilding Emergency Care After Hurricane Sandy

2014 ◽  
Vol 8 (2) ◽  
pp. 119-122 ◽  
Author(s):  
David C. Lee ◽  
Silas W. Smith ◽  
Christopher M. McStay ◽  
Ian Portelli ◽  
Lewis R. Goldfrank ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Emergency Care ◽  
New York State ◽  
Hurricane Sandy ◽  
Emergency Department Utilization ◽  
York State Department ◽  
Bellevue Hospital ◽  
Successful Operation ◽  
Hospital Center

AbstractA freestanding, 911-receiving emergency department was implemented at Bellevue Hospital Center during the recovery efforts after Hurricane Sandy to compensate for the increased volume experienced at nearby hospitals. Because inpatient services at several hospitals remained closed for months, emergency volume increased significantly. Thus, in collaboration with the New York State Department of Health and other partners, the Health and Hospitals Corporation and Bellevue Hospital Center opened a freestanding emergency department without on-site inpatient care. The successful operation of this facility hinged on key partnerships with emergency medical services and nearby hospitals. Also essential was the establishment of an emergency critical care ward and a system to monitor emergency department utilization at affected hospitals. The results of this experience, we believe, can provide a model for future efforts to rebuild emergency care capacity after a natural disaster such as Hurricane Sandy. (Disaster Med Public Health Preparedness. 2014;0:1-4)

Observation Services Linked With an Urgent Care Center in the Absence of an Emergency Department: An Innovative Mechanism to Initiate Efficient Health Care Delivery in the Aftermath of a Natural Disaster

2016 ◽  
Vol 10 (3) ◽  
pp. 405-410 ◽  
Author(s):  
Christopher Caspers ◽  
Silas W. Smith ◽  
Rishi Seth ◽  
Robert Femia ◽  
Lewis R. Goldfrank
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Natural Disaster ◽  
Performance Metrics ◽  
Care Delivery ◽  
Care Center ◽  
Hurricane Sandy ◽  
Urgent Care ◽  
Clinical Protocols ◽  
Urgent Care Center

AbstractObjectiveThe emergency department (ED) of NYU Langone Medical Center was destroyed by Hurricane Sandy, contributing to a public health disaster in New York City. We evaluated hospital-based acute care provided through the establishment of an urgent care center with an associated ED-run observation service (EDOS) that operated in the absence of an ED during this disaster.MethodsWe conducted a retrospective cohort study of all patients placed in an EDOS following a visit to an urgent care center during the 18 months of ED closure. We reviewed diagnoses, clinical protocols, selection criteria, and performance metrics.ResultsOf 55,723 urgent care center visits, 15,498 patients were hospitalized, and 3167 of all hospitalized patients (20.4%) were placed in the EDOS. A total of 2660 EDOS patients (84%) were discharged from the EDOS. The 8 most frequently utilized clinical protocols accounted for 76% of the EDOS volume.ConclusionsA diverse group of patients presenting to an urgent care center following the destruction of an ED by natural disaster can be cared for in an EDOS, regardless of association with a physical ED. An urgent care center with an associated EDOS can be implemented to provide patient care in a disaster situation. This may be useful when existing ED or hospital resources are compromised. (Disaster Med Public Health Preparedness. 2016;10:405–410)

scholarly journals Defining potentially preventable emergency department visits for older adults

2017 ◽  
Vol 3 (2) ◽  
pp. 1 ◽  
Author(s):  
Lesley P. Latham ◽  
Stacy Ackroyd-Stolarz
Keyword(s):  
Older Adults ◽  
New York ◽  
Hospital Admission ◽  
Literature Search ◽  
Care Delivery ◽  
Emergency Department Visits ◽  
New York University ◽  
Data Set ◽  
Ed Visits ◽  
Definition Of

Objective: As older adults become increasingly reliant on emergency departments (EDs) for care, there is an interest in determining what types of ED visits by this population may be preventable, or amenable to other forms of care. The aim of this project was to explore the concept of preventable ED visits by older adults.Methods: We conducted a literature search to identify definitions of “preventable” or “avoidable” ED visits. We then applied a definition of preventable ED visits to an administrative data set consisting of ED visit data extracted from four sites in Halifax, Nova Scotia, Canada. Visits for patients 65 years of age or older were eligible for inclusion. Visits were categorized using triage level and discharge diagnosis.Results: Four methods of defining preventable ED visits were identified in our literature search: 1) Ambulatory Care Sensitive Conditions (ACSCs) (N = 7), 2) Low Acuity/low intensity visits (N = 5), 3) New York University (NYU) (Billings) Algorithm (N = 3) and 4) hospital admission vs. non-admission (N = 1). We categorized 34,454 ED visits from our dataset using a modified definition of preventable ED visits that included ACSCs (15.3%) as well as low acuity visits that required no testing or hospital admission (9.9%).Conclusions: Our results suggest that approximately 25% of ED visits by older adults may be preventable or amenable to other forms of care. This data may be useful in the planning of care delivery appropriate for the needs of this population.

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