Background: In 2017, Hurricane Harvey caused record rainfall, with more than 50 inches in some parts of Houston, Texas, and led to greater than $100 billion in damages. During a disaster, emergency department (ED) volume slows. However, after a disaster, the need for emergency care is acute and it has been previously reported that ED visits rise post-disaster. Limited data exists comparing the local variation within a disaster zone. Texas has many freestanding EDs, and the impact of disasters on these centers is also unclear.
Methods: This abstract describes the impact of Hurricane Harvey on volume within a large hospital system through a retrospective, multi-center analysis of 11 hospital-based and 4 freestanding EDs. Data was abstracted from Cerner (Kansas City, MS) and descriptive statistics were used. The analysis compared three one-week time periods, before, during and after Hurricane Harvey (N=22253). The study examined one-week intervals beginning with the pre-storm week 8/19/17-8/25/17
Results: The 15 emergency departments, as a system, saw a decrease of 14.26% (range: 71.43% to -18.52% in patients in the week during the storm. The same system saw a 22.28% increase in patient volume from the week of the storm to the following week, with the rise ranging from 441.67% to -28.91% depending on the ED. Relative to hospital-based EDs, freestanding EDs saw a greater decrease in volume the week of the storm, 18.43% vs 14.26%, and a greater increase in volume the week after the storm, 34.73% vs 21.81%. When comparing the week after the storm to the week prior to the storm as a baseline, there was an overall increase in volume (4.84%) in the system, as well as among hospital-based EDs (4.64%) and freestanding EDs (9.90%). The mean Emergency Severity Index (ESI) was used as a marker for ED acuity and pre-storm, intra-storm, and post-storm weeks were similar with a mean ESI of 2.9, 2.9, 3.0, respectively.
Conclusion: Compared to the pre-storm week, emergency department use decreased during Hurricane Harvey, but post-storm volume surpassed pre-storm levels. Both freestanding and hospital-based EDs saw similar changes in patient volumes. However, large differences were seen in individual EDs in this region. Future disaster planning by ED leadership could benefit from including flexibility to move staff and resources to the departments with the highest need.