National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency?

2016 ◽  
Vol 10 (4) ◽  
pp. 576-582 ◽  
Author(s):  
Jennifer S. Love ◽  
David Karp ◽  
M. Kit Delgado ◽  
Gregg Margolis ◽  
Douglas J. Wiebe ◽  
...  
Keyword(s):  
Public Health ◽  
At Risk ◽  
Emergency Department ◽  
The United States ◽  
Public Health Emergency ◽  
Study Cohort ◽  
American Hospital ◽  
American Hospital Association ◽  
Hospital Referral ◽  
Increased Risk

AbstractObjectivesBoarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies.MethodsA retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering.ResultsA total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times.ConclusionsUrban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576–582)

scholarly journals Barriers to hospital electronic public health reporting and implications for the COVID-19 pandemic

2020 ◽  
Vol 27 (8) ◽  
pp. 1306-1309
Author(s):  
A Jay Holmgren ◽  
Nate C Apathy ◽  
Julia Adler-Milstein
Keyword(s):  
Public Health ◽  
Surveillance Data ◽  
Electronic Data ◽  
American Hospital ◽  
American Hospital Association ◽  
Public Health Agencies ◽  
Hospital Referral ◽  
Health Agencies ◽  
The Impact ◽  
To Receive

Abstract We sought to identify barriers to hospital reporting of electronic surveillance data to local, state, and federal public health agencies and the impact on areas projected to be overwhelmed by the COVID-19 pandemic. Using 2018 American Hospital Association data, we identified barriers to surveillance data reporting and combined this with data on the projected impact of the COVID-19 pandemic on hospital capacity at the hospital referral region level. Our results find the most common barrier was public health agencies lacked the capacity to electronically receive data, with 41.2% of all hospitals reporting it. We also identified 31 hospital referral regions in the top quartile of projected bed capacity needed for COVID-19 patients in which over half of hospitals in the area reported that the relevant public health agency was unable to receive electronic data. Public health agencies’ inability to receive electronic data is the most prominent hospital-reported barrier to effective syndromic surveillance. This reflects the policy commitment of investing in information technology for hospitals without a concomitant investment in IT infrastructure for state and local public health agencies.

scholarly journals National trends in emergency department closures, mergers, and utilization, 2005-2015

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251729
Author(s):  
Arjun K. Venkatesh ◽  
Alexander Janke ◽  
Craig Rothenberg ◽  
Edwin Chan ◽  
Robert D. Becher
Keyword(s):  
Emergency Department ◽  
Rural Areas ◽  
Urban Areas ◽  
Hospital Admissions ◽  
The United States ◽  
Relative Increase ◽  
American Hospital ◽  
American Hospital Association ◽  
Hospital Bed ◽  
Ed Visits

Study objectives To describe nationwide hospital-based emergency department (ED) closures and mergers, as well as the utilization of emergency departments and inpatient beds, over time and across varying geographic areas in the United States. Methods Observational analysis of the American Hospital Association (AHA) Annual Survey from 2005 to 2015. Primary outcomes were hospital-based ED closure and merger. Secondary outcomes were yearly ED visits per hospital-based ED and yearly hospital admissions per hospital bed. Results The total number of hospital-based EDs decreased from 4,500 in 2005 to 4,460 in 2015, with 200 closures, 138 mergers, and 160 new hospital-based EDs. While yearly ED visits per hospital-based ED exhibited a 28.6% relative increase (from 25,083 to 32,248), yearly hospital admissions per hospital bed had a 3.3% relative increase (from 45.4 to 43.9) from 2005 to 2015. The number of hospital admissions and hospital beds did not change significantly in urban areas and declined in rural areas. ED visits grew more uniformly across urban and rural areas. Conclusions The number of hospital-based ED closures is small when accounting for mergers, but occurs as many more patients are presenting to a stable number of EDs in larger health systems, though rural areas may differentially affected. EDs were managing accelerating patient volumes alongside stagnant inpatient bed capacity.

scholarly journals Who cannot work from home? Characterizing occupations facing increased risk during the COVID-19 pandemic using 2018 BLS data

2020 ◽  
Author(s):  
Marissa G. Baker
Keyword(s):  
Public Health ◽  
The United States ◽  
Public Health Emergency ◽  
Job Displacement ◽  
Public Health Emergencies ◽  
Work From Home ◽  
Working From Home ◽  
Increased Risk ◽  
The U.S ◽  
At Home

AbstractObjectivesNot all workers are employed in occupations in which working from home is possible. These workers are at an increased risk for exposure to infectious disease during a pandemic event, and are more likely to experience events of job displacement and disruption during all types of public health emergencies. Here, I characterized which occupational sectors in the United States are most able to work from home during a public health emergency such as COVID-19.Methods2018 national employment and wage data maintained by the U.S. Bureau of Labor Statistics (BLS) was merged with measures from the BLS O*NET survey data. The measures utilized rank the importance of using a computer at work, and the importance of working with or performing for the public, which relate to the ability to complete work at home.ResultsAbout 25% (35.6 M) of the U.S. workforce are employed in occupations which could be done from home, primarily in sectors such as technology, computer, management, administrative, financial, and engineering. The remaining 75% of U.S. workers (including healthcare, manufacturing, retail and food services, et al.) are employed in occupations where working from home would be difficult.ConclusionsThe majority of U.S. workers are employed in occupations that cannot be done at home, putting 108.4 M U.S. workers at increased risk for adverse health outcomes related to working during a public health emergency. These workers tend to be lower paid than workers who can work from home. During COVID-19, this could result in a large increase in the burden of mental health disorders in the U.S., in addition to increased cases of COVID-19 due to workplace transmission. Public health guidance to “work from home” is not applicable to the majority of the U.S. workforce, emphasizing the need for additional guidance for workers during public health emergencies.

Hepatitis B Vaccination Coverage Levels Among Healthcare Workers in the United States, 2002-2003

2007 ◽  
Vol 28 (7) ◽  
pp. 783-790 ◽  
Author(s):  
Edgar P. Simard ◽  
Jeremy T. Miller ◽  
Prethibha A. George ◽  
Annemarie Wasley ◽  
Miriam J. Alter ◽  
...  
Keyword(s):  
United States ◽  
At Risk ◽  
Hepatitis B ◽  
Vaccination Coverage ◽  
Healthcare Workers ◽  
The United States ◽  
Care Staff ◽  
Hepatitis B Vaccination ◽  
American Hospital ◽  
American Hospital Association

Background.Hepatitis B virus (HBV) infection is a well recognized risk for healthcare workers (HCWs), and routine vaccination of HCWs has been recommended since 1982. By 1995, the level of vaccination coverage among HCWs was only 67%.Objective.To obtain an accurate estimate of hepatitis B vaccination coverage levels among HCWs and to describe the hospital characteristics and hepatitis B vaccination policies associated with various coverage levels.Design.Cross-sectional survey.Methods.A representative sample of 425 of 6,116 American Hospital Association member hospitals was selected to participate, using probability-proportional-to-size methods during 2002-2003. The data collected included information regarding each hospital's hepatitis B vaccination policies. Vaccination coverage levels were estimated from a systematic sample of 25 HCWs from each hospital whose medical records were reviewed for demographic and vaccination data. The main outcome measure was hepatitis B vaccination coverage levels.Results.Among at-risk HCWs, 75% had received 3 or more doses of the hepatitis B vaccine, corresponding to an estimated 2.5 million vaccinated hospital-based HCWs. The coverage level was 81% among staff physicians and nurses. Compared with nurses, coverage was significantly lower among phlebotomists (71.1%) and nurses' aides and/or other patient care staff (70.9%; P < .05). Hepatitis B vaccination coverage was highest among white HCWs (79.5%) and lowest among black HCWs (67.6%; P < .05). Compared with HCWs who worked in hospitals that required vaccination only of HCWs with identified risk for exposure to blood or other potentially infectious material, hepatitis B vaccination coverage was significantly lower among HCWs who worked in hospitals that required vaccination of HCWs without identified risk for exposure to blood or other potentially infectious material (76.6% vs 62.4%; P < .05).Conclusions.In the United States, an estimated 75% of HCWs have been vaccinated against hepatitis B. Important differences in coverage levels exist among various demographic groups. Hospitals need to identify methods to improve hepatitis B vaccination coverage levels and should consider developing targeted vaccination programs directed at unvaccinated, at-risk HCWs who have frequent or potential exposure to blood or other potentially infectious material.

scholarly journals At-Risk populations and public health emergency preparedness in the United States: Nursing leadership in communities

2021 ◽  
Vol 69 (4) ◽  
pp. 699-703
Author(s):  
Mary Pat Couig ◽  
Jasmine L. Travers ◽  
Barbara Polivka ◽  
Jessica Castner ◽  
Tener Goodwin Veenema ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
At Risk ◽  
Emergency Preparedness ◽  
The United States ◽  
Nursing Leadership ◽  
Public Health Emergency ◽  
Public Health Emergency Preparedness ◽  
At Risk Populations

Analysis of Hospital Resource Availability and COVID-19 Mortality Across the United States

2021 ◽  
pp. E1-E4
Author(s):  
Alexander T Janke ◽  
Hao Mei ◽  
Craig Rothenberg ◽  
Robert D Becher ◽  
Zhenqiu Lin ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
New York Times ◽  
General Medicine ◽  
The United States ◽  
American Hospital ◽  
American Hospital Association ◽  
Hospital Referral ◽  
Hospital Resources ◽  
The Impact

While the impact of coronavirus disease 2019 (COVID-19) has varied greatly across the United States, there has been little assessment of hospital resources and mortality. We examine hospital resources and death counts among hospital referral regions (HRRs) from March 1 to July 26, 2020. This was an analysis of American Hospital Association data with COVID-19 data from the New York Times. Hospital-based resource availabilities were characterized per COVID-19 case. Death count was defined by monthly confirmed COVID-19 deaths. Geographic areas with fewer intensive care unit (ICU) beds (incident rate ratio [IRR], 0.194; 95% CI, 0.076-0.491), nurses (IRR, 0.927; 95% CI, 0.888-0.967), and general medicine/surgical beds (IRR, 0.800; 95% CI, 0.696-0.920) per COVID-19 case were statistically significantly associated with greater deaths in April. This underscores the potential impact of innovative hospital capacity protocols and care models to create resource flexibility to limit system overload early in a pandemic.

A Silenced Population

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 433-442 ◽  
Author(s):  
Kim Gryglewicz ◽  
Melanie Bozzay ◽  
Brittany Arthur-Jordon ◽  
Gabriela D. Romero ◽  
Melissa Witmeier ◽  
...  
Keyword(s):  
At Risk ◽  
Depressive Symptomatology ◽  
The United States ◽  
Future Research ◽  
At Risk Youth ◽  
Peer Relationship ◽  
Student Records ◽  
Cross Sectional ◽  
Increased Risk ◽  
Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

scholarly journals Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhong Li ◽  
Sayward E. Harrison ◽  
Xiaoming Li ◽  
Peiyin Hung
Keyword(s):  
Continuity Of Care ◽  
Psychiatric Care ◽  
The United States ◽  
Psychiatric Services ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Promising Alternative ◽  
American Hospital ◽  
American Hospital Association ◽  
Inpatient Psychiatric Care

Abstract Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

Expanding the concept of the professional integrity of obstetrics during a public health emergency

2020 ◽  
Vol 48 (5) ◽  
pp. 435-437 ◽  
Author(s):  
Frank A. Chervenak ◽  
Amos Grünebaum ◽  
Eran Bornstein ◽  
Shane Wasden ◽  
Adi Katz ◽  
...  
Keyword(s):  
Public Health ◽  
New York ◽  
Clinical Judgment ◽  
Ethical Judgment ◽  
Population Based ◽  
Public Health Emergency ◽  
Ethical Challenge ◽  
Professional Integrity ◽  
Increased Risk ◽  
Obstetric Services

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has placed great demands on many hospitals to maximize their capacity to care for affected patients. The requirement to reassign space has created challenges for obstetric services. We describe the nature of that challenge for an obstetric service in New York City. This experience raised an ethical challenge: whether it would be consistent with professional integrity to respond to a public health emergency with a plan for obstetric services that would create an increased risk of rare maternal mortality. We answered this question using the conceptual tools of professional ethics in obstetrics, especially the professional virtue of integrity. A public health emergency requires frameshifting from an individual-patient perspective to a population-based perspective. We show that an individual-patient-based, beneficence-based deliberative clinical judgment is not an adequate basis for organizational policy in response to a public health emergency. Instead, physicians, especially those in leadership positions, must frameshift to population-based clinical ethical judgment that focuses on reduction of mortality as much as possible in the entire population of patients served by a healthcare organization.

THE PRESIDENT'S PAGE

PEDIATRICS ◽  
1951 ◽  
Vol 8 (2) ◽  
pp. 275-276
Author(s):  
PAUL W. BEAVEN
Keyword(s):  
Public Health ◽  
New York ◽  
School Health ◽  
News Letter ◽  
American Hospital ◽  
American Hospital Association ◽  
Contagious Diseases ◽  
National Foundation ◽  
Health Laws ◽  
Infantile Paralysis

I AM SURE that the majority of our members are not aware of the influence of the Academy in public health and child welfare. For this reason I will recount some of the incidents that have occurred in the past few months which illustrate this. In May, Dr. Edward Davens, representing our Committee on School Health, went to a meeting in Washington arranged by the National Educational Association to examine the real meaning of citizenship in our country. Excerpts from his report will be published in the News Letter. Last January, Dr. Reginald Higgons attended a conference on school health in Cleveland, which he reported in full to the Executive Board and which will appear in the agenda of committees published in Pediatrics. I would commend this to anyone interested in school health work. In April, Dr. Stewart Clifford used the report of this same School Health Committee, of which Dr. Thomas Shaffer is Chairman, to modify the school health laws in Massachusetts to conform to its recommendations. If members in states are attempting to introduce modern practices in school health, they are referred to the central office. Dr. Christopherson will be glad to send them a copy of Dr. Shaffer's report. In February, Dr. Danis' Committee on Hospitals and Dispensaries sent representatives to a meeting in New York, called to discuss the care of contagious diseases in a general hospital. This group represented many organizations, including the American Public Health Association, the American Medical Association, the American Hospital Association, the American Nursing Association, and others. It was financed by the National Foundation for Infantile Paralysis.

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