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Redistribution of Emergency Department Patients After Disaster-Related Closures of a Public Versus Private Hospital in New York City

Published online by Cambridge University Press:  17 March 2015

David C. Lee ,
Silas W. Smith ,
Brendan G. Carr ,
Lewis R. Goldfrank  and
Daniel Polsky
David C. Lee*
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine Department of Population Health, New York University School of Medicine, and RWJF Clinical Scholars Program, University of Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania
Silas W. Smith
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine
Brendan G. Carr
Affiliation:
Department of Emergency Medicine, Kimmel School of Medicine, Thomas Jefferson University, and Emergency Care Coordination Center, Office of the Assistant Secretary for Preparedness & Response, Department of Health & Human Services
Lewis R. Goldfrank
Affiliation:
Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine
Daniel Polsky
Affiliation:
Leonard Davis Institute of Health Economics, University of Pennsylvania Department of Health Care Management, The Wharton School, University of Pennsylvania, and Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania.
*
Correspondence and reprint requests to David C. Lee, Departments of Emergency Medicine and Population Health, NYU School of Medicine, 462 First Avenue, Room A345, New York, NY 10016 (e-mail: david.lee@nyumc.org).
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Abstract

Sudden hospital closures displace patients from usual sources of care and force them to access facilities that lack their prior medical records. For patients with complex needs and for nearby hospitals already strained by high volume, disaster-related hospital closures induce a public health emergency. Our objective was to analyze responses of patients from public versus private emergency departments after closure of their usual hospital after Hurricane Sandy. Using a statewide database of emergency visits, we followed patients with an established pattern of accessing 1 of 2 hospitals that closed after Hurricane Sandy: Bellevue Hospital Center and NYU Langone Medical Center. We determined how these patients redistributed for emergency care after the storm. We found that proximity strongly predicted patient redistribution to nearby open hospitals. However, for patients from the closed public hospital, this redistribution was also influenced by hospital ownership, because patients redistributed to other public hospitals at rates higher than expected by proximity alone. This differential response to hospital closures demonstrates significant differences in how public and private patients respond to changes in health care access during disasters. Public health response must consider these differences to meet the needs of all patients affected by disasters and other public health emergencies. (Disaster Med Public Health Preparedness. 2015;9:256-264).

Keywords

hurricanedisaster medicinepublic healthemergency medicinesurge capacity
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 9 , Issue 3 , June 2015 , pp. 256 - 264
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

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