Skip to main content Accessibility help
×
Home

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

  • Christopher Caspers (a1), Silas W. Smith (a1), Rishi Seth (a2), Robert Femia (a1) and Lewis R. Goldfrank (a1)...

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)

Copyright

Corresponding author

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).

References

Hide All
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.
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.
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.
4. American College of Emergency Physicians. Observation Medicine https://www.acep.org/Physician-Resources/Practice-Resources/Administration/Observation-Medicine/. Accessed September 17, 2015.
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.
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.
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.
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.
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.
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.
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.
12. Graff, L. Observation Medicine. Boston, MA: Andover Medical Publishers; 1993.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed