title: An Analysis of the Relationship Between the Heat Index and Arrivals in the Emergency Department.
abstract: BACKGROUND
  Heatwaves are one of the most deadly weather-related events in the United States and account for more deaths annually than hurricanes, tornadoes, floods, and earthquakes combined. However, there are few statistically rigorous studies of the effect of heatwaves on emergency department (ED) arrivals. A better understanding of this relationship can help hospitals plan better and provide better care for patients during these types of events.
  
  
  METHODS
  A retrospective review of all ED patient arrivals that occurred from April 15 through August 15 for the years 2008 through 2013 was performed. Daily patient arrival data were combined with weather data (temperature and humidity) to examine the potential relationships between the heat index and ED arrivals as well as the length of time patients spend in the ED using generalized additive models. In particular the effect the 2012 heat wave that swept across the United States, and which was hypothesized to increase arrivals was examined.
  
  
  RESULTS
  While there was no relationship found between the heat index and arrivals on a single day, a non-linear relationship was found between the mean three-day heat index and the number of daily arrivals. As the mean three-day heat index initially increased, the number of arrivals significantly declined. However, as the heat index continued to increase, the number of arrivals increased. It was estimated that there was approximately a 2% increase in arrivals when the mean heat index for three days approached 100°F. This relationship was strongest for adults aged 18-64, as well as for patients arriving with lower acuity. Additionally, a positive relationship was noted between the mean three-day heat index and the length of stay (LOS) for patients in the ED, but no relationship was found for the time from which a patient was first seen to when a disposition decision was made. No significant relationship was found for the effect of the 2012 heat wave on ED arrivals, though it did have an effect on patient LOS.
  
  
  CONCLUSIONS
  A single hot day has only a limited effect on ED arrivals, but continued hot weather has a cumulative effect. When the heat index is high (~90°F) for a number of days in a row, this curtails peoples activities, but if the heat index is very hot (~100°F) this likely results in an exacerbation of underlying conditions as well as heat-related events that drives an increase in ED arrivals. Periods of high heat also affects the length of stay of patients either by complicating care or by making it more difficult to discharge patients.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Levy
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Broccoli
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Gai
authors.initials: G
authors.lastname: Cole
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: J Lee
authors.initials: JL
authors.lastname: Jenkins
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Disease Dynamics, Economics, and Policy, Washington, DC.
authors.forename: Eili Y
authors.initials: EY
authors.lastname: Klein