title: Impact of Hurricane Sandy on hospital emergency and dialysis services: a retrospective survey.
abstract: OBJECTIVE
  Hurricane Sandy forced closures of many free-standing dialysis centers in New York City in 2012. Hemodialysis (HD) patients therefore sought dialysis treatments from nearby hospitals. The surge capacity of hospital dialysis services was the rate-limiting step for streamlining the emergency department flow of HD patients. The aim of this study was to determine the extent of the HD patients surge and to explore difficulties encountered by hospitals in Brooklyn, New York (USA) due to Hurricane Sandy.
  
  
  METHODS
  A retrospective survey on hospital dialysis services was conducted by interviewing dialysis unit managers, focusing on the influx of HD patients from closed dialysis centers to hospitals, coping strategies these hospitals used, and difficulties encountered.
  
  
  RESULTS
  In total, 347 HD patients presented to 15 Brooklyn hospitals for dialysis. The number of transient HD patients peaked two days after landfall and gradually decreased over a week. Hospital dialysis services reported issues with lack of dialysis documentation from transient dialysis patients (92.3%), staff shortage (50%), staff transportation (71.4%), and communication with other agencies (53.3%). Linear regression showed that factors significantly associated with enhanced surge capacity were the size of inpatient dialysis unit (P = .040), having affiliated outpatient dialysis centers (P = .032), using extra dialysis machines (P = .014), and having extra workforce (P = .007). Early emergency plan activation (P = .289) and shortening treatment time (P = .118) did not impact the surge capacity significantly in this study.
  
  
  CONCLUSIONS
  These findings provide potential improvement options for receiving hospitals dialysis units to prepare for future events.
authors: State University of New York Downstate Medical Center,Brooklyn,New YorkUSA.
authors: Chou-Jui
authors: CJ
authors: Lin
authors: State University of New York Downstate Medical Center,Brooklyn,New YorkUSA.
authors: Lauren C
authors: LC
authors: Pierce
authors: State University of New York Downstate Medical Center,Brooklyn,New YorkUSA.
authors: Patricia M
authors: PM
authors: Roblin
authors: State University of New York Downstate Medical Center,Brooklyn,New YorkUSA.
authors: Bonnie
authors: B
authors: Arquilla
mesh_terms: D055867:Cyclonic Storms; D004189:Disaster Planning; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006271:Health Facility Closure; D006801:Humans; D009519:New York City; D006435:Renal Dialysis; D012189:Retrospective Studies; D055872:Surge Capacity; D011795:Surveys and Questionnaires