New York City Hospital Research Articles

Disparities in neurosurgical care: Using length of stay to evaluate efficiency of care in New York City hospitals

Objective: We sought to analyze public and private hospital patient cohorts in New York City (NYC) to assess differences in hospital access and outcomes from 2009-2022.Methods: Inpatient neurosurgical discharges, as determined by APR-DRG codes, from 2009-2022 were aggregated for seven NYC hospitals, four private and three public, via the Statewide Planning and Research Cooperative System (SPARCS). Statistical analyses (Z-tests) were performed in Python.Results: 325,351 patients were identified, 223,361 private and 101,990 public. Private hospitals had lower high-severity to low-severity and higher high-mortality to low-mortality risk ratios relative to public hospitals (p < .001). Public hospitals treated a higher proportion of stroke and trauma (p < .001). Average length of stay (LOS) was shorter at private hospitals compared to public (5.3 vs. 7.1 days, p < .001). Statistical significance remained when stratifying for illness severity and elective versus non-elective surgery status. Interestingly, cranial trauma cases were associated with a longer LOS in private hospitals relative to public (7.9 vs. 5.7 days, p < .001).Conclusions: While many factors influence outcomes in private versus public hospitals, LOS can mark the efficiency of care. LOS was shorter at private hospitals in all instances except with cranial trauma. Care efficiency is important for hospital reimbursement, which can directly impact available resources for patient care. These findings emphasize the need to further analyze patient accessibility to neurosurgical care at private hospitals and the resources necessary to support neurosurgical practices within public hospitals.

Hospital segregation, critical care strain, and inpatient mortality during the COVID-19 pandemic in New York City.

Hospital segregation by race, ethnicity, and health insurance coverage is prevalent, with some hospitals providing a disproportionate share of undercompensated care. We assessed whether New York City (NYC) hospitals serving a higher proportion of Medicaid and uninsured patients pre-pandemic experienced greater critical care strain during the first wave of the COVID-19 pandemic, and whether this greater strain was associated with higher rates of in-hospital mortality. In a retrospective analysis of all-payer NYC hospital discharge data, we examined changes in admissions, stratified by use of intensive care unit (ICU), from the baseline period in early 2020 to the first COVID-19 wave across hospital quartiles (265,329 admissions), and crude and risk-adjusted inpatient mortality rates, also stratified by ICU use, in the first COVID wave across hospital quartiles (23,032 inpatient deaths), based on the proportion of Medicaid or uninsured admissions from 2017-2019 (quartile 1 lowest to 4 highest). Logistic regressions were used to assess the cross-sectional association between ICU strain, defined as ICU volume in excess of the baseline average, and patient-level mortality. ICU admissions in the first COVID-19 wave were 84%, 97%, 108%, and 123% of the baseline levels by hospital quartile 1-4, respectively. The risk-adjusted mortality rates for ICU admissions were 36.4 (CI = 34.7,38.2), 43.6 (CI = 41.5,45.8), 45.9 (CI = 43.8,48.1), and 45.7 (CI = 43.6,48.0) per 100 admissions, and those for non-ICU admissions were 8.6 (CI = 8.3,9.0), 10.9 (CI = 10.6,11.3), 12.6 (CI = 12.1,13.0), and 12.1 (CI = 11.6,12.7) per 100 admissions by hospital quartile 1-4, respectively. Compared with the reference group of 100% or less of the baseline weekly average, ICU admissions on a day for which the ICU volume was 101-150%, 151-200%, and > 200% of the baseline weekly average had odds ratios of 1.17 (95% CI = 1.10, 1.26), 2.63 (95% CI = 2.31, 3.00), and 3.26 (95% CI = 2.82, 3.78) for inpatient mortality, and non-ICU admissions on a day for which the ICU volume was 101-150%, 151-200%, and > 200% of the baseline weekly average had odds ratios of 1.28 (95% CI = 1.22, 1.34), 2.60 (95% CI = 2.40, 2.82), and 3.44 (95% CI = 3.11, 3.63) for inpatient mortality. Our findings are consistent with hospital segregation as a potential driver of COVID-related mortality inequities and highlight the need to desegregate health care to address structural racism, advance health equity, and improve pandemic resiliency.

Clinical Characteristics of COVID-19 Coagulopathy, Experiences in a New York City Safety Net Hospital

Purpose/Objective: COVID-19 is a significant cause of morbidity and mortality in the inner-city population in New York City (NYC), with COVID-19 coagulopathy and venous thromboembolism (VTE) as major contributing factors. A recent meta-analysis of 17 studies demonstrated a pooled 25% increased risk of VTE incidence in hospitalized COVID-19 patients (Zhang et. al, 2020). To assess morbidity burden, the primary objective of this current study is to investigate COVID-19 coagulopathy incidence in hospitalized patients in an Afro-Caribbean NYC population. The secondary objective was to assess the clinical characteristics and risk factors of COVID-19 coagulopathy, classify disease severity and outcomes. Methods: A retrospective study was performed at the NYC Health and Hospitals/Kings County on patients hospitalized with COVID-19. Data was collected from March 1 st, 2020 to December 31 st, 2021 for hospitalized and intensive care patients. Information was collected on the incidence of VTE, type of VTE (deep vein thrombosis or pulmonary embolism), demographics, VTE prevention strategies, VTE management, inflammatory markers, and outcomes. GraphPad PRISM was used for statistical analysis, through unpaired t-tests and odds ratios, with p<0.05 indicating statistical significance. Results: The primary objective investigated 675 patients to assess COVID-19 incidence, with imaging-confirmed VTE incidence in 32 (4.74%), and mortality in 112 (16.6%) patients (Table 1). To assess factors that influence VTE, we assessed demographic, outcome and infection severity between 32 VTE patients, and 142 non-VTE patients (Table 2). Multivariable analysis of comorbidities demonstrated that obesity was an independent risk factor for VTE (OR=11.4938, 95% CI 4.3512 to 30.3615, p<0.001). Interestingly, prior VTE did not increase the risk of VTE between cohorts. Further, there is a trend towards increased mortality risk in VTE patients compared to non-VTE patients, although not statistically significant (OR= 2.7483, 95% CI 0.9332 to 8.0934, p=0.0666). We were unable to deduce differences between VTE prevention strategies between the cohorts due to insufficient power. Upon analyzing inflammatory markers, D-Dimers were determined to be significantly elevated in VTE patients compared to non-VTE patients (p=0.0274), whereas there was no significant difference between LDH or ferritin between the cohorts. Conclusions/Implications: This study characterized the incidence and demographics of COVID-19 coagulopathy in a safety net NYC hospital, wherein there is decreased VTE incidence compared to prior published literature (Zhang et. al, 2020). Our study also supports current literature which identifies obesity as a risk factor for VTE in COVID-19 patients (Wang et al, 2021). We hypothesize that BMI reduction may be protective against COVID-19 induced VTE risk, and targeted BMI reduction programs may mitigate COVID-19 severity. Future studies should continue to investigate COVID-19 risk reduction strategies in patients with comorbidities and can consider anticoagulation use based on risk factors.

Civilian Medical Responder Perspectives to a Federal Military Medical Deployment in New York City during the COVID-19 Pandemic

Objectives This study aims to describe the civilian experience and perceptions of the patient coordination and management at the interface of the New York City (NYC) civilian and the military health systems during a large-scale public health emergency. Methods A qualitative study design was implemented with interviews conducted using a basic descriptive approach. Purposive sampling was used to recruit participants with experience working during the first wave of COVID-19 in NYC. Inclusion criteria were civilians who worked at the Javits Center, the USNS Comfort, or NYC hospitals, who interfaced with patient transfer and military personnel during the city-wide medical response to COVID-19. Semi-structured video interviews were conducted between July 20, 2021 and March 11, 2022. Results Civilian responders working in the clinical and transfer operations of patients to military facilities in NYC during March and April of 2020 described initial confusion, as well as logistical (patient selection, transfer logistics, patient tracking), communication, and leadership challenges. While the military deployment was felt to be necessary to address the surge capacity in hospitals, the lack of clarity about military medical resources and frameworks for response resulted in confusion about what was being offered by the military deployment. This was balanced by the positive impression of working with military members and the resources that they brought to the response more generally. The need for future trainings and exercises were highlighted. Conclusions Initial challenges with civilian-military roles and responsibilities, regional needs assessment, patient selection, and logistics were ultimately resolved through adaptation of civilian and military leadership. Improvements in patient tracking, medical records, and standard hospital admission and discharge functions for patients in military alternative care facilities were identified as areas for improvement. Civilian government, health care, and military leaders should consider these ideas when planning for future military deployments in support of a domestic medical response.

Survival in Newly Created Hospital Units in Response to COVID 19 Pandemic Crisis

Importance: New York City (NYC) was the first major US city struck by the novel Coronavirus (COVID-19) with significant infection rates, mechanical intubations, and subsequent mortality. New hospital units were created to accommodate the surge of pandemic patients. Objective: The objective of this study is to examine the outcomes of COVID-19 patients admitted to a community teaching NYC hospital with newly created units and compare them to outcomes of patients admitted to established hospital units to determine if there is a mortality difference. Design: We retrospectively collected data on patients hospitalized with laboratory-confirmed COVID-19 infection between March 8, 2020 and April 7, 2020. Included were patient demographics, comorbidities, risk factors, clinical factors, laboratory data, imaging studies, hospital course, and outcomes obtained from our electronic medical records. Data were analyzed between two cohorts: new hospital units (NHU) and established hospital units (EHU) to determine if a mortality difference existed. Setting: The study is based on a 454-bed community teaching hospital in NYC at a location that serves an ethnically diverse population using population-based data. Participants: All patients included in our study were 17 years or greater in age. The study endpoint was defined as either patient discharge or death, and pregnant women and patients who died in the Emergency Department before admission were excluded from the analysis. Results: Of the 1288 screened patients, 351 confirmed COVID-19 hospitalized patients were included in our analysis. Specifically, the racial demographics for African Americans were similar between both units (p=0.139). Factors such as elevated BUN, ferritin, lactate dehydrogenase, and troponin were found to be similar in both cohorts. Overall survival was higher for patients in EHU compared to NHU (p=.012). The mortality rate was most striking in the NHU ICU where the mortality, especially in patients on mechanical ventilation (MV), was higher than in EHU ICU units (p = <.004). Conclusion: Our analysis revealed that patients admitted to newly created hospital units had a significantly lower overall survival rate compared to those admitted to established units, particularly in the NHU ICUs, especially for MV patients. These findings highlight the need for better planning, including the development of protocols that encompass trained providers' assignment, competency, proper orientation to the new unit, team cohesion, familiarity with the equipment, and critically ill patients' allocation. Such measures can help mitigate the survivorship disadvantage observed during surges in hospitalizations, particularly when NHU, especially new ICUs, need to be created.

Stress and the Psychological Impact of the COVID-19 Pandemic on Frontline Obstetrics and Gynecology Providers.

The coronavirus disease 2019 (COVID-19) pandemic rapidly overwhelmed global health care systems in 2020, with New York City (NYC) marking the first epicenter in the United States. High levels of stress amongst health care workers have been reported in pandemics, but less is known about stress amongst Obstetrics and Gynecology (OB/GYN) providers. We sought to describe levels of stress, anxiety, depression, and other aspects of mental health among OB/GYN health care workers during the first wave of the COVID-19 pandemic. We conducted an anonymous cross-sectional electronic survey of a wide range of OB/GYN clinicians in a large NYC hospital system in the spring of 2020. We used both original survey questions and validated screening tools to assess stress, anxiety, depression, and burnout. We calculated median scores for these tools and compared median score between provider types. We also adapted questions on pandemic-related stressors from the MERS and SARS pandemics to fit the context of the COVID-19 pandemic and OB/GYN providers. A total of 464 providers met study inclusion criteria, and 163 providers completed the survey (response rate = 35.1%). Approximately 35% of providers screened positive for anxiety and 21% for depression. Scores for depression, burnout, and fulfillment varied by provider type, with nurses scoring higher than physicians (p <0.05). The majority of respondents reported stress from pandemic and OB-specific stressors, including the possibility of transmitting COVID-19 to friends and family (83.9%, [95% confidence interval or CI 78.0-89.8%]), uncertainty regarding the pandemic's trajectory (91.3% [86.7-95.8%]), and frequent policy changes on labor and delivery (72.7% [65.1-80.3%]). OB/GYN providers reported high levels of stress during the COVID-19 pandemic. The stress of caring for laboring patients during a pandemic may disproportionately affect nurses and trainees and highlights the need to provide interventions to ameliorate the negative impact of a pandemic on the mental health of our OB/GYN health care workers. · COVID-19 led to stress amongst OB/GYN providers.. · Some stressors were unique to providing obstetric care.. · Nurses and trainees were more affected by this stress..

The impact of the ban on elective surgery in New York City during the coronavirus outbreak on gynecologic oncology patient care

IntroductionElective surgical procedures were suspended during the coronavirus disease pandemic (COVID-19) in New York City (NYC) between March 16 and June 15, 2020. This study characterizes the impact of the ban on surgical delays for patients scheduled for surgery during this first wave of the COVID-19 outbreak. MethodsPatients who were scheduled for surgical treatment of malignant or pre-invasive disease by gynecologic oncologists at three NYC hospitals during NYC’s ban on elective surgery were included. Outcomes of interest were the percentage of patients experiencing surgical delay and the nature of delays. Kruskal-Wallis, chi-square, and logistic regression tests were performed with significance set at p < 0.05. ResultsOf the 145 patients with malignant or pre-invasive diseases scheduled for surgery during the ban on elective surgery, 40% of patients experienced one or more surgical delays, 10% experienced two or more and 1% experienced three surgical delays. Of patients experiencing an initial delay, 77% were hospital-initiated and 11% were due to known or suspected personal COVID-19. Overall, 81% of patients completed their planned treatment, and 93% of patients underwent their initially planned surgery. Among patients for whom adjuvant therapy was recommended, 67% completed their planned treatment, and the most common reasons for not completing treatment were medically indicated followed by concerns regarding COVID-19. ConclusionDuring the ban on elective surgery in NYC during the first outbreak of the COVID-19 pandemic, many patients experienced minor surgical delays, but most patients obtained appropriate, timely care with either surgery or alternative treatment.

Frontline love: Romantic partners of frontline doctors and nurses during the New York City COVID-19 outbreak.

ObjectiveThis qualitative study's aim was to learn how the spouses and romantic partners of frontline doctors and nurses dealt with the acute stress of the outbreak; the kinds of support they provided when the frontliners had to navigate COVID‐19 at their hospitals; and, according to their perceptions, how this crisis impacted their relationship.BackgroundThis study focused on the partners of frontliners working in hospitals during the crisis of the coronavirus outbreak in New York City (NYC)—one of the earliest epicenters of the COVID‐19 pandemic in the United States. This study expanded upon the Family Stress Model—which examines how economic problems can affect marital quality and stability.MethodInterviews were conducted with 29 partners of frontliners who had been treating COVID‐19 patients in NYC hospitals during the pandemic outbreak from February 29 to June 1, 2020. Partners were recruited via snowball sampling, interviewed via Zoom or telephone, and results were analyzed using thematic content analysis.ResultsThe following themes were found in the narratives: The burden of running the home independently; providing various kinds of support (concrete, emotional, and refraining from sexual and physical closeness); and the effects of the pandemic on the relationship via writing a will and discussing the possibility of death, the lack of relationship‐ending threats, and emerging from the crisis with a strengthened relationship.ConclusionThe pandemic crisis unified the partners and frontliners, even in the face of multiple stressors.

Impact of Coronavirus Disease 2019 (COVID-19) on emergency department visits for ectopic pregnancies in New York City

Background: Ectopic pregnancy is a potential cause of morbidity and mortality among women and is a common diagnosis for women presenting to the emergency room. During the height of the COVID-19 pandemic in New York City (NYC) in the spring of 2020, emergency room visits for all non-COVID related health problems appeared to decrease. We examined visits for ectopic pregnancies and pregnancies of unknown location (PUL) in the emergency department (ED) of three NYC hospitals during the height of the early pandemic and compared them to the same months in the prior year. Methods: Our study is an IRB-approved retrospective chart review of all patients who presented to the ED with a positive pregnancy test during the months of March–June 2020 (pandemic period) and March–June 2019 (pre-pandemic). Demographic data, history, labs, imaging, number of visits and treatment and outcomes were measured. Results: We found that there were 324 ED visits for PUL in 2019 (pre-pandemic) compared to 195 in 2020 (pandemic). Ectopic pregnancies remained somewhat stable and were diagnosed in 59 patients in 2019 and 51 patients in 2020. The percentage of patients diagnosed with ectopic pregnancy increased from 25.1% of all patients with PUL in 2019 to 39% of all patients diagnosed with PUL in 2020. Rates of complications were similar between the two cohorts. Conclusion: Although the number of visits to the ED for PUL fell dramatically from the pre-pandemic to the pandemic time period, the number of patients actually diagnosed with ectopic pregnancy was similar between the two time periods.

Uniformed Services and the Field Hospital Experience During Coronovirus Disease 2019 (SARS-CoV-2) Pandemic: Open to Closure in 30 Days With 1,100 Patients: The Javits New York Medical Station.

ABSTRACTIntroductionThe surge of SARS-CoV-2-virus infected (COVID-19) patients presenting to New York City (NYC) hospitals quickly overwhelmed and outnumbered the available acute care and intensive care resources in NYC in early March 2020. Upon the arrival of military medical assets to the Javits Convention Center in NYC, the planned mission to care for non-SARS-CoV-2 patients was immediately changed to manage patients with (SARS-CoV-2)COVID-19 and their comorbid conditions.Healthcare professionals from every branch of the uniformed services, augmented by state and local resources, staffed the Javits New York Medical Station (JNYMS) from April 2020.Methods The data review reported aggregated summary statistics and participant observations collected by N.Y. State and U.S. military officials.ResultsDuring the 28 days of patient intake at the JNYMS, 1,095 SARS-CoV-2-positive patients were transferred from NYC hospitals to the JNYMS. At its peak, the JNYMS accepted 119 patients in a single day, had a maximum census of 453, and had a peak intensive care unit census of 35. The median length of stay was 4.6 days (interquartile range: 3.1-6.9 days). A total of 103 patients were transferred back to local hospitals, and there were 6 deaths, with an overall mortality rate of 0.6% (95% CI, 0.3-1.2).Discussion and ConclusionsThis is the first report of the care provided at the JNYMS. Within 2 weeks, this multi-agency effort was able to mobilize to care for over 1,000 SARS-CoV-2 patients with varying degrees of illness in a 1-month period. This was the largest field hospital mobilization in the U.S. medical history in response to a non-wartime pandemic. Its success with huge patient throughput including disposition and low mortality relieved critical overcrowding and supply deficiencies throughout NYC hospitals. The downstream impact likely saved additional hundreds of lives and reduced stress on the system during this healthcare crisis.

Proper Use and Compliance of Facial Masks During the COVID-19 Pandemic: An Observational Study of Hospitals in New York City.

Proper mask usage is a cornerstone of the prevention of COVID-19 transmission. Hospitals, in particular, are important settings for proper mask compliance due to the risk for viral exposure. Despite the presence of health care personnel and financial resources to ensure proper compliance, mask usage is variable in health care settings. The impact of mask compliance is particularly important in New York City (NYC) because of the burden of COVID-19 and at-risk demographics. We conducted a prospective observational study in 4 NYC hospitals assessing rates of proper mask compliance among adult patients entering the hospital. Six hundred unique individuals were observed for proper mask fit, exposure of the nose and mouth, and the presence of nontraditional face coverings in lieu of a mask at 4 NYC hospitals. Proper mask usage is a large health education gap that must be addressed by health care administrations and governmental agencies, as mask usage continues to be an effective form of COVID-19 prevention.

The impact and efficiency of medical screening exams in forward treatment areas at New York City public hospitals during the initial COVID-19 surge.

BackgroundNew York City (NYC) emergency departments (EDs) experienced a surge of patients because of coronavirus disease 2019 (COVID‐19) in March 2020. NYC Health and Hospitals established rapid medical screening exams (MSE) and each hospital designated areas to perform their MSE. Five of the 11 hospitals created a forward treatment area (FTA) external to the ED to disposition patients before entering who presented with COVID‐like symptoms. Three hospitals used paper‐based, and 2 used an electronic medical record (EMR)‐based MSE. This study evaluated the effectiveness of safely discharging patients home from the FTA while also evaluating the efficiency of using paper‐based versus EMR‐based MSEs.MethodsCharts were reviewed using standardized data extraction templates. Patients discharged from the FTA were contacted by phone, and a structured interview captured additional data regarding subsequent clinical courses. Chi‐square tests were used to compare proportions of patients hospitalized, as well as proportions of patients with vital signs recorded. Mortality rates were compared with Fisher exact test. A logistic regression model with fixed effects to account for clustering at hospitals was used to compare the odds of being sent to the ED for further evaluation based on vital signs and adjusted for age and sexResultsAcross 5 EDs, 3335 patients were evaluated in their FTAs from March 17, 2020, to April 27, 2020. A total of 970 (29.1%) patients were referred for further evaluation into the ED, of which 203 (20.9%) were hospitalized and 19 (2.0%) died. Of 2302 patients discharged from the FTA, 182 (7.9%) returned to the ED within 7 days, resulting in 42 (1.8%) hospitalizations and 7 (0.3%) deaths. Facilities using EMR‐MSE discharged more patients from their FTA (81.9% vs 65.3%, P < 0.001) and had similar 7‐day return (9.3% vs 7.1%, P = 0.055) and mortality rates (0.49% vs 0.20%, P = 0.251).ConclusionMSEs in an FTA are an effective process to disposition patients safely in a high‐volume situation. Differences exist in paper‐ versus EMR‐based approaches, suggesting EMR‐MSEs provide better data, efficiency, and effectiveness. This suggests prioritizing an EMR‐based MSE should be considered in future circumstances.

HIV Diagnosis and the Clinical Course of COVID-19 Among Patients Seeking Care Within the New York City Public Hospital System During the Initial Pandemic Peak.

Reports conflict on how HIV infection influences the clinical course of COVID-19. The New York City (NYC) public hospital system provides care for over 14,000 people with HIV, was central in responding to the COVID-19 pandemic, and is therefore in a unique position to evaluate the intersection of these concurrent infections. Retrospective chart review of patients presenting to NYC Health and Hospitals (NYC H+H) diagnosed with COVID-19 infection from March 1, 2020, through April 28, 2020, compared people living with HIV (PLWH) and a propensity-matched (PM) control group of patients without HIV to evaluate associations between HIV status and COVID-19 outcomes. Two hundred thirty-four PLWH presented for COVID-19 testing and 110 (47%) were diagnosed with COVID-19. Among 17,413 patients with COVID-19 and without HIV, 1:n nearest neighbor propensity score matching identified 194 patients matched on age, sex, race, and any comorbidity. In the sample with COVID-19 (N = 304), PLWH (9.1%) had lower rates of mortality than controls [19.1%; PM odds ratio (PM-OR): 0.41, 95% confidence interval (CI): 0.19-0.86]. Among hospitalized COVID-19 patients (N = 179), HIV infection was associated with lower rates of mechanical ventilation (PM-OR: 0.31, 95% CI: 0.11-0.84) and mortality (PM-OR: 0.40, 95% CI: 0. 17-0.95). In the extended pandemic period through April 2021, aggregate data by HIV status suggested elevated hospitalization and mortality rates in PLWH versus people without HIV. These results suggest that the direct biological impacts of the HIV virus do not negatively influence COVID-19-related outcomes when controlling for comorbidity and demographic variables.

Hospital-level factors associated with death during pneumonia-associated hospitalization among adults-New York City, 2010-2014.

BackgroundIn New York City (NYC), pneumonia is a leading cause of death and most pneumonia deaths occur in hospitals. Whether the pneumonia death rate in NYC reflects reporting artifact or is associated with factors during pneumonia-associated hospitalization (PAH) is unknown. We aimed to identify hospital-level factors associated with higher than expected in-hospital pneumonia death rates among adults in NYC.MethodsData from January 1, 2010–December 31, 2014 were obtained from the New York Statewide Planning and Research Cooperative System and the American Hospital Association Database. In-hospital pneumonia standardized mortality ratio (SMR) was calculated for each hospital as observed PAH death rate divided by expected PAH death rate. To determine hospital-level factors associated with higher in-hospital pneumonia SMR, we fit a hospital-level multivariable negative binomial regression model.ResultsOf 148,172 PAH among adult NYC residents in 39 hospitals during 2010–2014, 20,820 (14.06%) resulted in in-hospital death. In-hospital pneumonia SMRs varied across NYC hospitals (0.77–1.23) after controlling for patient-level factors. An increase in average daily occupancy and membership in the Council of Teaching Hospitals were associated with increased in-hospital pneumonia SMR.ConclusionsDifferences in in-hospital pneumonia SMRs between hospitals might reflect differences in disease severity, quality of care, or coding practices. More research is needed to understand the association between average daily occupancy and in-hospital pneumonia SMR. Additional pneumonia-specific training at teaching hospitals can be considered to address higher in-hospital pneumonia SMR in teaching hospitals.

Evaluation of Data Sources for Carbon Monoxide Poisoning Surveillance in New York City.

Carbon monoxide (CO) exposure can be life-threatening. Suspected and confirmed cases of CO poisoning warranting health care in New York City (NYC) are reportable to the NYC Poison Control Center (PCC). We evaluated 4 hospital-based sources of CO surveillance data to identify ways to improve data capture and reporting. Suspected and confirmed CO poisoning records from October 2015 through December 2016 were collected from the NYC emergency department (ED) syndromic surveillance system, New York State Statewide Planning and Research Cooperative System (SPARCS) ED billing data, NYC PCC calls made from hospitals, and the Electronic Clinical Laboratory Reporting System (ECLRS). Syndromic and SPARCS records were person- and visit-matched. SPARCS and ECLRS records were also matched to PCC records on combinations of name, demographic characteristics, and visit information. Hospitals in NYC. Individuals who visited NYC hospitals for CO-related health effects. We assessed the validity of syndromic data, with SPARCS records as the gold standard. We matched SPARCS and ECLRS records to PCC records to analyze reporting rates by case characteristics. The sensitivity of syndromic surveillance was 60% (225 true-positives detected among 372 visit-matched SPARCS cases), and positive predictive value was 46%. Syndromic records often missed CO flags because of a nonspecific or absent International Classification of Diseases code in the diagnosis field. Only 15% of 428 SPARCS records (total includes 56 records not visit-matched to syndromic) and 16% of 199 ECLRS records were reported to PCC, with male sex and younger age associated with higher reporting. Mandatory reporting makes PCC useful for tracking CO poisoning in NYC, but incomplete reporting and challenges in distinguishing between confirmed and suspected cases limit its utility. Simultaneous tracking of the systems we evaluated can best reveal surveillance patterns.

High ambient temperature and child emergency and hospital visits in New York City.

BackgroundEmerging literature has documented heat‐related impacts on child health, yet few studies have evaluated the effects of heat among children of different age groups and comparing emergency department (ED) and hospitalisation risks.ObjectivesTo examine the differing associations between high ambient temperatures and risk of ED visits and hospitalisations among children by age group in New York City (NYC).MethodsWe used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0–18 years admitted to NYC EDs (n = 2,252,550) and hospitals (n = 228,006) during the warm months (May‐September) between 2005 and 2011. Using a time‐stratified, case‐crossover design, we estimated the risk of ED visits and hospitalisations associated with daily maximum temperature (Tmax) for children of all ages and by age group.ResultsThe average Tmax over the study period was 80.3°F (range 50°, 104°F). Tmax conferred the greatest risk of ED visits for children aged 0–4, with a 6‐day cumulative excess risk of 2.4% (95% confidence interval [CI] 1.7, 3.0) per 13°F (ie interquartile range) increase in temperature. Children and adolescents 5–12 years (0.8%, 95% CI 0.1, 1.6) and 13–18 years (1.4%, 95% CI 0.6, 2.3) are also sensitive to heat. For hospitalisations, only adolescents 13–18 years had increased heat‐related risk, with a cumulative excess risk of 7.9% (95% CI 2.0, 14.2) per 13°F increase in Tmax over 85°F.ConclusionsThis urban study in NYC reinforces that young children are particularly vulnerable to effects of heat, but also demonstrates the sensitivity of older children and adolescents as well. These findings underscore the importance of focussing on children and adolescents in targeting heat illness prevention and emergency response activities, especially as global temperatures continue to rise.

150 Management of diabetes in pregnancy during the COVID-19 pandemic at a New York City hospital

To compare diabetic control and maternal and neonatal outcomes in pregnant women during the Coronavirus 2019 (COVID-19) pandemic to women managed one year prior. This was a retrospective cohort study of pregnant women with diabetes managed either during the COVID-19 pandemic or one year earlier. Twenty-two gestational and pregestational diabetic subjects were identified in a city hospital clinic during the peak of the pandemic in New York City (NYC) from March 15, 2020 until May 31, 2020. Fifty-seven pregnant diabetic subjects were identified who were managed at this clinic during the same timeframe in 2019. Demographics and maternal and neonatal outcomes were collected and compared. Diabetic control was compared by measuring change in hemoglobin A1c and diabetic medication regimen at time of delivery. Outcomes documented included mode of delivery, gestational age at delivery, postpartum hemorrhage, maternal infection, birth weight, shoulder dystocia, APGAR score <7, fetal acidosis, NICU admission, neonatal glucose level and neonatal demise. Secondary outcomes included number of virtual or in person visits, COVID-19 status, and gestational age at time of the diabetes diagnosis. Patients managed during the COVID-19 pandemic had significantly more telehealth visits and fewer in person visits compared to the year prior (p<0.001). However, no significant differences in maternal or neonatal outcomes or diabetic control were noted. There was no significant change in mode of delivery (p>0.999), shoulder dystocia (p=0.075), macrosomia (p>0.999), APGARs (p=0.671) or change in hemoglobin A1c during pregnancy (p=0.342). There were no significant differences in maternal or neonatal outcomes or diabetic control for subjects managed during the COVID-19 pandemic in a NYC hospital. A decreased number of in person visits, substituted with telehealth visits, had no apparent negative effect on outcomes or diabetic control.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Machine Learning Highlights Downtrending of COVID-19 Patients with a Distinct Laboratory Profile.

New York City (NYC) experienced an initial surge and gradual decline in the number of SARS-CoV-2-confirmed cases in 2020. A change in the pattern of laboratory test results in COVID-19 patients over this time has not been reported or correlated with patient outcome. We performed a retrospective study of routine laboratory and SARS-CoV-2 RT-PCR test results from 5,785 patients evaluated in a NYC hospital emergency department from March to June employing machine learning analysis. A COVID-19 high-risk laboratory test result profile (COVID19-HRP), consisting of 21 routine blood tests, was identified to characterize the SARS-CoV-2 patients. Approximately half of the SARS-CoV-2 positive patients had the distinct COVID19-HRP that separated them from SARS-CoV-2 negative patients. SARS-CoV-2 patients with the COVID19-HRP had higher SARS-CoV-2 viral loads, determined by cycle threshold values from the RT-PCR, and poorer clinical outcome compared to other positive patients without the COVID12-HRP. Furthermore, the percentage of SARS-CoV-2 patients with the COVID19-HRP has significantly decreased from March/April to May/June. Notably, viral load in the SARS-CoV-2 patients declined, and their laboratory profile became less distinguishable from SARS-CoV-2 negative patients in the later phase. Our longitudinal analysis illustrates the temporal change of laboratory test result profile in SARS-CoV-2 patients and the COVID-19 evolvement in a US epicenter. This analysis could become an important tool in COVID-19 population disease severity tracking and prediction. In addition, this analysis may play an important role in prioritizing high-risk patients, assisting in patient triaging and optimizing the usage of resources.

449. Disproportionate of COVID-19 Mortality across NYC: Experience from the Bronx Hospital during the First Wave of Pandemic Crisis

BackgroundThe Bronx (BX) is an urban city with the most poverty, least educated population and poorest health outcomes among 62 counties in New York State. Unsurprisingly, BX has the highest rates of COVID-19 diagnoses across New York City (NYC). Lincoln Medical Center (LMC) is part of the NYC health and hospital system (NYC H+H) and has the highest COVID-19 admissions in BX and the second-highest across NYC. Herein we report our preliminary data on mortality rate (MR) of hospitalized COVID-19 patients and discuss the disproportionate of MR across NYC.MethodsOn 26 April 2020, we acquired the total number of hospitalized COVID-19 and deaths and mechanically ventilated (MV) COVID-19 and death from LMC and all other NYC H+H. Scheffe test was used to determine MR differences. The P-value (p) < 0.005 was set as a statistically significant threshold.ResultsMR of our hospitalized COVID-19 patients was 31%, which is higher than that of Man (24%, p 0.001). However, LMC has a high proportion of MV COVID-19 (local and transferred cases). Sub-group analysis of non-MV COVID-19 showed LMC MR (6%) is lower than Brooklyn (BL) (17%, p 0.00) and Queens (Qu) (17%, p 0.00) and didn’t differ from Man NYC H+H centers (8%, p 0.68). Analysis of MR among MV patients between LMC and other NYC H+H centers across four boroughs did not discover any differences.Hospitalized COVID-19 MR from all NYC H+H centers in BX (28%) did not differ from Man (24%, p 0.7) and Qu (28%, p 0.99). Interestingly, we found that MR is the highest in BL (33%). Moreover, MR of non-MV COVID-19 was higher in BL (17%) and Qu (17%) than BX (10%) and Man (8%) NYC H+H centers. We hypothesize this may result partly from the tense and shortage of health care resources in these two boroughs, especially, at the beginning of pandemic so some critical patients may not receive adequate care such as delaying intubation. Further research investigating reasons for this disproportion will help in developing the best available care plan for the ongoing crisis.Percentage of COVID-19 Mortality in each group Multiple comparison by Scheffe Test of MR of hospitalized patients with COVID-19 at LMC and across 4 NYC boroughs Multiple comparison by Scheffe Test of MR of non-MV patients with COVID-19 at LMC and across 4 NYC boroughs ConclusionDespite the high COVID-19 incidence and poor epidemiologic health risks of the population in BX, MR of hospitalized COVID-19 seemed to be the same as Man and Qu, and surprisingly lower than BL. MR of non-MV COVID-19 in BX is lower than BL and Qu. The studies determining the reasons underlying this disproportionate would be worthwhile.Disclosures All Authors: No reported disclosures

Detection and genetic characterization of community-based SARS-CoV-2 infections – New York City, March 2020

To limit SARS-CoV-2 introduction, the United States restricted travel from China on February 2 and from Europe on March 13, 2020 By March 15, community transmission was widespread in New York City (NYC) The NYC Department of Health and Mental Hygiene conducted sentinel surveillance of influenza-like symptoms (ILS) and genetic sequencing to characterize community transmission and determine the geographic origin of SARS-CoV-2 infections Among 544 specimens tested from persons with ILS and negative influenza test results, 36 (6 6%) were positive Genetically sequenced positive specimens most closely resembled sequences circulating in Europe Partnering with health care facilities and establishing systems for sentinel surveillance with capacity for genetic sequencing before an outbreak can inform timely public health response strategies