Wettstein Zachary S, Hall Jane, Buck Cameron, Mitchell Steven H, Hess Jeremy J
Department of Emergency Medicine University of Washington School of Medicine Seattle Washington USA.
Center for Health and the Global Environment University of Washington School of Public Health Seattle Washington USA.
J Am Coll Emerg Physicians Open. 2024 Jan 20;5(1):e13098. doi: 10.1002/emp2.13098. eCollection 2024 Feb.
Extreme heat events (EHEs) are associated with excess healthcare utilization but specific impacts on emergency department (ED) operations and throughput are unknown. In 2021, the Pacific Northwest experienced an unprecedented heat dome that resulted in substantial regional morbidity and mortality. The aim of this study was to examine its impact on ED utilization, unplanned hospitalization, and hospital operations in a large academic healthcare system.
Retrospective electronic medical records from three Seattle-area hospitals were used to compare healthcare utilization during the EHE compared to a pre-event reference period within the same month. Interrupted time series analysis was used to evaluate the association between EHE exposure and ED visits and hospitalizations. Metrics of ED crowding for the EHE were compared to the reference period using Student's -tests and chi-squared tests. Additionally, multivariable Poisson regression was used to identify risk factors for heat-related illness and hospital admission.
Interrupted time series analysis showed an increase of 21.7 ED visits per day (95% confidence interval [CI] = 14.7, 28.6) and 9.9 unplanned hospitalizations per day (95% CI = 8.3, 11.5) during the EHE, as compared to the reference period. ED crowding and process measures also displayed significant increases, becoming the most pronounced by day 3 of the EHE; the EHE was associated with delays in ED length of stay of 1.0 h (95% CI = 0.4, 1.6) compared to the reference period. Higher incidence rate ratios for heat-related illness were observed for patients who were older (incidence rate ratio [IRR] = 1.02; 95% CI = 1.01,1.03), female (IRR = 1.47; 95% CI = 1.06, 2.04), or who had pre-existing diabetes (IRR = 3.19; 95% CI = 1.47, 6.94).
The 2021 heat dome was associated with a significant increase in healthcare utilization including ED visits and unplanned hospitalizations. Substantial impacts on ED and hospital throughput were also noted. These findings contribute to the understanding of the role extreme heat events play on impacting patient outcomes and healthcare system function.
极端高温事件（EHEs）与医疗保健利用率过高有关，但对急诊科（ED）运营和患者流量的具体影响尚不清楚。2021年，太平洋西北地区经历了一场前所未有的热穹顶，导致该地区出现大量发病和死亡情况。本研究的目的是调查其对一个大型学术医疗系统中ED利用率、非计划住院率和医院运营的影响。
利用西雅图地区三家医院的回顾性电子病历，将EHE期间的医疗保健利用率与同月事件发生前的参考期进行比较。采用中断时间序列分析来评估EHE暴露与ED就诊和住院之间的关联。使用学生t检验和卡方检验将EHE期间的ED拥挤指标与参考期进行比较。此外，使用多变量泊松回归来确定与中暑和住院相关的风险因素。
中断时间序列分析显示，与参考期相比，EHE期间每天的ED就诊次数增加了21.7次（95%置信区间[CI]=14.7,28.6），非计划住院次数增加了9.9次（95%CI=8.3,11.5）。ED拥挤和流程指标也显著增加，在EHE的第3天最为明显；与参考期相比，EHE与ED住院时间延迟1.0小时（95%CI=0.4,1.6）有关。年龄较大（发病率比[IRR]=1.02；95%CI=1.01,1.03）、女性（IRR=1.47；95%CI=1.06,2.04）或患有糖尿病（IRR=3.19；95%CI=1.47,6.94）的患者中暑发病率更高。
2021年的热穹顶与包括ED就诊和非计划住院在内的医疗保健利用率显著增加有关。还注意到对ED和医院患者流量产生了重大影响。这些发现有助于理解极端高温事件在影响患者结局和医疗系统功能方面所起的作用。
