Abstract
IntroductionNational health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. We sought to quantify changes in healthcare utilization patterns for an at-risk Medicare population before, during, and after Superstorm Sandy’s 2012 landfall in New Jersey (NJ).MethodsThis study is a retrospective cohort study of Medicare beneficiaries impacted by Superstorm Sandy. We compared hospital emergency department (ED) and healthcare facility inpatient utilization in the weeks before and after Superstorm Sandy landfall using a 20% random sample of Medicare fee-for-service beneficiaries continuously enrolled in 2011 and 2012 (N=224,116). Outcome measures were pre-storm discharges (or transfers), average length of stay, service intensity weight, and post-storm ED visits resulting in either discharge or hospital admission.ResultsIn the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year. In the post-storm week, ED visits increased by 14% statewide; of these additional “surge” patients, 20% were admitted to the hospital. The increase in ED demand was more than double the statewide average in the most highly impacted coastal regions (35% versus 14%).ConclusionSuperstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall ED surge was associated with overall storm impact, which was greatest in coastal counties. A significant increase in the number and severity of pre-storm transfer patients, in particular from SNF, as well as in post-storm ED visits and inpatient admissions, draws attention to the importance of collaborative regional approaches to healthcare in large-scale events.
Highlights
National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event
In the pre-storm week, hospital transfers from skilled nursing facilities (SNF) increased by 39% and inpatient discharges had a 0.3 day decreased mean length of stay compared to the prior year
Superstorm Sandy impacted both pre- and post-storm patient movement in New Jersey; post-landfall emergency department (ED) surge was associated with overall storm impact, which was greatest in coastal counties
Summary
National health security requires that healthcare facilities be prepared to provide rapid, effective emergency and trauma care to all patients affected by a catastrophic event. A key responsibility of the healthcare system is to anticipate, prepare for, and accommodate the increased demand for services following a catastrophic event, which is often referred to as “surge capacity.”[1] Surge capacity is directly related to patient health outcomes. Impact of Superstorm Sandy on Medicare Patients’ Utilization of Hospitals and EDs patients.[2] Increased hospital utilization after a disaster may result from illness or injury that is a direct effect of the event, as was the case following the 2013 Boston Marathon bombing or the 2016 Orlando nightclub shooting, or it may result from the movement of patients evacuated from a healthcare facility that can no longer care for them, as is common during severe flooding or sustained loss of electrical power. The ability of receiving facilities to conduct evidence-based surge capacity planning is compromised
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