title: Observation Services Linked With an Urgent Care Center in the Absence of an Emergency Department: An Innovative Mechanism to Initiate Efficient Health Care Delivery in the Aftermath of a Natural Disaster.
abstract: The emergency department (ED) of NYU Langone Medical Center was destroyed by Hurricane Sandy, contributing to a public health disaster in New York City. We evaluated hospital-based acute care provided through the establishment of an urgent care center with an associated ED-run observation service (EDOS) that operated in the absence of an ED during this disaster.
  
  
  
  We conducted a retrospective cohort study of all patients placed in an EDOS following a visit to an urgent care center during the 18 months of ED closure. We reviewed diagnoses, clinical protocols, selection criteria, and performance metrics.
  
  
  
  Of 55,723 urgent care center visits, 15,498 patients were hospitalized, and 3167 of all hospitalized patients (20.4%) were placed in the EDOS. A total of 2660 EDOS patients (84%) were discharged from the EDOS. The 8 most frequently utilized clinical protocols accounted for 76% of the EDOS volume.
  
  
  
  A diverse group of patients presenting to an urgent care center following the destruction of an ED by natural disaster can be cared for in an EDOS, regardless of association with a physical ED. An urgent care center with an associated EDOS can be implemented to provide patient care in a disaster situation. This may be useful when existing ED or hospital resources are compromised. (Disaster Med Public Health Preparedness. 2016;10:405-410).
authors.affiliation: 1Ronald O. Perelman Department of Emergency Medicine,NYU School of Medicine,New York,New York.
authors.forename: Christopher
authors.initials: C
authors.lastname: Caspers
authors.affiliation: 1Ronald O. Perelman Department of Emergency Medicine,NYU School of Medicine,New York,New York.
authors.forename: Silas W
authors.initials: SW
authors.lastname: Smith
authors.affiliation: 2NYU Langone Medical Center,New York,New York.
authors.forename: Rishi
authors.initials: R
authors.lastname: Seth
authors.affiliation: 1Ronald O. Perelman Department of Emergency Medicine,NYU School of Medicine,New York,New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Femia
authors.affiliation: 1Ronald O. Perelman Department of Emergency Medicine,NYU School of Medicine,New York,New York.
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Goldfrank
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D015331:Cohort Studies; D055867:Cyclonic Storms; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006271:Health Facility Closure / Q000639:trends; D006801:Humans; D008297:Male; D009519:New York City; D019370:Observation / Q000379:methods*; D012189:Retrospective Studies
keywords: Hurricane Sandy; disaster; emergency department; observation medicine; urgent care