Impacts of the 2021 heat dome on emergency department visits, hospitalizations, and health system operations in three hospitals in Seattle, Washington

Zachary S Wettstein; Jane Hall; Cameron Buck; Steven H Mitchell; Jeremy J Hess

doi:10.1002/emp2.13098

Impacts of the 2021 heat dome on emergency department visits, hospitalizations, and health system operations in three hospitals in Seattle, Washington

J Am Coll Emerg Physicians Open. 2024 Jan 20;5(1):e13098. doi: 10.1002/emp2.13098. eCollection 2024 Feb.

Authors

Zachary S Wettstein^{1

2}, Jane Hall¹, Cameron Buck¹, Steven H Mitchell^{1

3}, Jeremy J Hess^{1

2}

Affiliations

¹ Department of Emergency Medicine University of Washington School of Medicine Seattle Washington USA.
² Center for Health and the Global Environment University of Washington School of Public Health Seattle Washington USA.
³ Washington Medical Coordination Center Seattle Washington USA.

Abstract

Objectives: Extreme heat events (EHEs) are associated with excess healthcare utilization but specific impacts on emergency department (ED) operations and throughput are unknown. In 2021, the Pacific Northwest experienced an unprecedented heat dome that resulted in substantial regional morbidity and mortality. The aim of this study was to examine its impact on ED utilization, unplanned hospitalization, and hospital operations in a large academic healthcare system.

Methods: Retrospective electronic medical records from three Seattle-area hospitals were used to compare healthcare utilization during the EHE compared to a pre-event reference period within the same month. Interrupted time series analysis was used to evaluate the association between EHE exposure and ED visits and hospitalizations. Metrics of ED crowding for the EHE were compared to the reference period using Student's t-tests and chi-squared tests. Additionally, multivariable Poisson regression was used to identify risk factors for heat-related illness and hospital admission.

Results: Interrupted time series analysis showed an increase of 21.7 ED visits per day (95% confidence interval [CI] = 14.7, 28.6) and 9.9 unplanned hospitalizations per day (95% CI = 8.3, 11.5) during the EHE, as compared to the reference period. ED crowding and process measures also displayed significant increases, becoming the most pronounced by day 3 of the EHE; the EHE was associated with delays in ED length of stay of 1.0 h (95% CI = 0.4, 1.6) compared to the reference period. Higher incidence rate ratios for heat-related illness were observed for patients who were older (incidence rate ratio [IRR] = 1.02; 95% CI = 1.01,1.03), female (IRR = 1.47; 95% CI = 1.06, 2.04), or who had pre-existing diabetes (IRR = 3.19; 95% CI = 1.47, 6.94).

Conclusions: The 2021 heat dome was associated with a significant increase in healthcare utilization including ED visits and unplanned hospitalizations. Substantial impacts on ED and hospital throughput were also noted. These findings contribute to the understanding of the role extreme heat events play on impacting patient outcomes and healthcare system function.

Keywords: climate change; disaster; heat; heat wave; operations.