title: Absorbing citywide patient surge during Hurricane Sandy: a case study in accommodating multiple hospital evacuations.
abstract: OBJECTIVE
  Hospital evacuations have myriad effects on all elements of the health care system. We seek to (1) examine the effect of patient surge on hospitals that received patients from evacuating hospitals in New York City during Hurricane Sandy; (2) describe operational challenges those hospitals faced pre- and poststorm; and (3) examine the coordination efforts to distribute patients to receiving hospitals.
  
  
  METHODS
  We used a qualitative, interview-based method to identify medical surge strategies used at hospitals receiving patients from evacuated health care facilities during and after Hurricane Sandy. We identified 4 hospital systems that received the majority of evacuated patients and those departments most involved in managing patient surge. We invited key staff at those hospitals to participate in on-site group interviews.
  
  
  RESULTS
  We interviewed 71 key individuals. Although all hospitals had emergency preparedness plans in place before Hurricane Sandy, we identified gaps. Insights gleaned included improvement opportunities in these areas: prolonged increased patient volume, an increase in the number of methadone and dialysis patients, ability to absorb displaced staff, the challenges associated with nursing homes that have evacuated and shelters that have already reached capacity, and reimbursements for transferred patients.
  
  
  CONCLUSIONS
  Our qualitative, event-based research identified key opportunities to improve disaster preparedness. The specific opportunities and this structured postevent approach can serve to guide future disaster planning and analyses.
authors.affiliation: UPMC Center for Health Security, Baltimore, MD; Department of Emergency Medicine, Department of Critical Care Medicine, and Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: aadalja@upmc.edu.
authors.forename: Amesh A
authors.initials: AA
authors.lastname: Adalja
authors.affiliation: UPMC Center for Health Security, Baltimore, MD.
authors.forename: Matthew
authors.initials: M
authors.lastname: Watson
authors.affiliation: UPMC Center for Health Security, Baltimore, MD.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Bouri
authors.affiliation: UPMC Center for Health Security, Baltimore, MD.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Minton
authors.affiliation: UPMC Center for Health Security, Baltimore, MD.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Morhard
authors.affiliation: UPMC Center for Health Security, Baltimore, MD.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Toner
mesh_terms: D055867:Cyclonic Storms; D004189:Disaster Planning / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D055317:Evidence-Based Practice; D006271:Health Facility Closure; D006801:Humans; D009519:New York City; D010360:Patient Transfer / Q000458:organization & administration*; D036301:Qualitative Research; D055872:Surge Capacity