Impact of Hurricane Harvey on Healthcare Utilization and Emergency Department Operations

Abstract

Introduction: Hurricanes have increased in severity over the past 35 years, and climate change has led to an increased frequency of catastrophic flooding. The impact of floods on emergency department (ED) operations and patient health has not been well studied. We sought to detail challenges and lessons learned from the severe weather event caused by Hurricane Harvey in Houston, Texas, in August 2017.Methods: This report combines narrative data from interviews with retrospective data on patient volumes, mode of arrival, and ED lengths of stay (LOS). We compared the five-week peri-storm period for the 2017 hurricane to similar periods in 2015 and 2016.Results: For five days, flooding limited access to the hospital, with a consequent negative impact on provider staffing availability, disposition and transfer processes, and resource consumption. Interruption of patient transfer capabilities threatened patient safety, but flexibility of operations prevented poor outcomes. The total ED patient census for the study period decreased in 2017 (7062 patients) compared to 2015 (7665 patients) and 2016 (7770) patients). Over the five-week study period, the arrival-by-ambulance rate was 12.45% in 2017 compared to 10.1% in 2016 (p < 0.0001) and 13.7% in 2015 (p < 0.0001). The median ED length of stay (LOS) in minutes for admitted patients was 976 minutes in 2015 (p < 0.0001) compared to 723 minutes in 2016 and 591 in 2017 (p < 0.0001). For discharged patients, median ED LOS was 336 minutes in 2016 compared to 356 in 2015 (p < 0.0001) and 261 in 2017 (p < 0.0001). Median boarding time for admitted ED patients was 284 minutes in 2016 compared to 470 in 2015 (p < 0.0001) and 234.5 in 2017 (p < 0.001). Water damage resulted in a loss of 133 of 179 inpatient beds (74%). Rapid and dynamic ED process changes were made to share ED beds with admitted patients and to maximize transfers postflooding to decrease ED boarding times. Conclusion:A number of pre-storm preparations could have allowed for smoother and safer ride-out functioning for both hospital personnel and patients. These measures include surplus provisioning of staff and supplies to account for limited facility access. During a disaster, innovative flexibility of both ED and hospital operations may be critical when disposition and transfer capibilities or bedding capacity are compromised. [

Extreme Weather and Climate Change: Population Health and Health System Implications

“…Health care access and infrastructure can be severely affected by floods, including loss of records, impacts on water supplies and laboratory functions, reduced access to health care, and evacuation, with subsequent consequences for the communities served (21,139). Health care access was particularly reduced for persons living in households where someone lost their job after Hurricane Harvey (50).…”

Emergency department visits associated with satellite observed flooding during and following Hurricane Harvey

“…Our results suggest that after the landfall of Hurricane Harvey, there was a decrease in ED visits in flooded tracts compared to nonflooded tracts. An overall decrease in ED visits following Hurricane Harvey as well as Hurricane Sandy has been noted in previous studies [39][40][41]. This decrease might be due to evacuation of residents, transport difficulty to health care facilities due to submerged or blocked roads, or closures or reduced capacity of health care facilities due to infrastructure damage or reduced workforce.…”

Pediatric Emergency Departments and Urgent Care Visits in Houston after Hurricane Harvey

“…22 A similar decrease in total ED patient visits at a large county hospital in the metro Houston area in the four weeks following Hurricane Harvey was noted. 23 Conversely, the decrease in percentage of inpatient admissions in early fall 2017 compared to the same period of the prior year may reflect the fact that in the immediate period following Hurricane Harvey, many primary care offices were closed and families that had access to transportation used our EDs and UCCs for non-urgent care. Unlike other medical facilities, our facilities did not incur any physical damage, flooding, or loss of power during the storm.…”

“… 11 , 20 , 21 This possible explanation is supported by a study from the closest major metropolitan area that reported an 11% increase in ED visits in the Dallas-Fort Worth area in the month following Hurricane Harvey, with an associated increase in patients who reported residing in the metro Houston area and presented with chief complaints that included the words “hurricane,” “Harvey,” “evacuee,” or “evacuate.” 22 A similar decrease in total ED patient visits at a large county hospital in the metro Houston area in the four weeks following Hurricane Harvey was noted. 23 …”