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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

Published online by Cambridge University Press:  18 April 2016

Christopher Caspers ,
Silas W. Smith ,
Rishi Seth ,
Robert Femia  and
Lewis R. Goldfrank
Christopher Caspers*
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York
Silas W. Smith
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York
Rishi Seth
Affiliation:
NYU Langone Medical Center, New York, New York.
Robert Femia
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York
Lewis R. Goldfrank
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, New York
*
Correspondence and reprint requests to Christopher Caspers, MD, Ronald O. Perelman Department of Emergency Medicine, Bellevue Hospital Center, 462 First Avenue, Room A-345A, New York, New York 10016 (e-mail: Christopher.Caspers@nyumc.org).
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Abstract

Objective

The 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.

Methods

We 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.

Results

Of 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.

Conclusions

A 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)

Keywords

observation medicinedisasteremergency departmenturgent careHurricane Sandy
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Special Issue 3: Superstorm Sandy , June 2016 , pp. 405 - 410
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2016 

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References

1. NYU’s ER After Sandy - Optimists at Work. http://www.nyu.edu/about/news-publications/nyu-stories/dr--goldfrank-on-langone-er-re-opening.html. Accessed September 25, 2015.Google Scholar
2. Jangi, S. Facing uncertainty--dispatch from Beth Israel Medical Center, Manhattan. N Engl J Med. 2012;367(24):2267-2269. http://dx.doi.org/10.1056/NEJMp1213844.CrossRefGoogle ScholarPubMed
3. Lee, D, Smith, S, McStay, C, et al. Rebuilding emergency care after Hurricane Sandy. Disaster Med Public Health Prep. 2014;8(2):119-122. http://dx.doi.org/10.1017/dmp.2014.19.CrossRefGoogle ScholarPubMed
4. American College of Emergency Physicians. Observation Medicine https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Observation-Medicine/. Accessed September 17, 2015.Google Scholar
5. Gilboy, N, Tanabe, P, Travers, D, et al. Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, Version 4. Implementation Handbook 2012 Edition. AHRQ Publication No. 12-0014. Rockville, MD: Agency for Healthcare Research and Quality; 2011.Google Scholar
6. Sun, B, McCreath, H, Liang, L, et al. Randomized clinical trial of an emergency department observation syncope protocol vs. routine inpatient admission. Ann Emerg Med. 2014;64(2):167-175. http://dx.doi.org/10.1016/j.annemergmed.2013.10.029.CrossRefGoogle Scholar
7. Gomez, MA, Anderson, JL, Karagounis, LA, et al. An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO). J Am Coll Cardiol. 1996;28(1):25-33. http://dx.doi.org/10.1016/0735-1097(96)00093-9.CrossRefGoogle ScholarPubMed
8. Ross, MA, Compton, S, Medado, P, et al. An emergency department diagnostic protocol for patients with transient ischemic attack: a randomized controlled trial. Ann Emerg Med. 2007;50(2):109-119. http://dx.doi.org/10.1016/j.annemergmed.2007.03.008.CrossRefGoogle ScholarPubMed
9. Robinson, D, Woods, P, Snedeker, C, et al. A comparison trial for stratifying intermediate-risk chest pain: benefits of emergency department observation centers. Prev Cardiol. 2002;5(Winter):23-30. http://dx.doi.org/10.1111/j.1520-037X.2002.00550.x.CrossRefGoogle ScholarPubMed
10. Shen, WK, Decker, WW, Smars, PA, et al. Syncope Evaluation in the Emergency Department Study (SEEDS): a multidisciplinary approach to syncope management. Circulation. 2004;110(24):3636-3645. http://dx.doi.org/10.1161/01.CIR.0000149236.92822.07.CrossRefGoogle Scholar
11. Hadden, D, Dearden, C, Rocke, L. Short stay observation patients: general wards are inappropriate. J Accid Emerg Med. 1996;13(3):163-165. http://dx.doi.org/10.1136/emj.13.3.163.CrossRefGoogle ScholarPubMed
12. Graff, L. Observation Medicine. Boston, MA: Andover Medical Publishers; 1993.Google Scholar