Publications

Introduction: Heatwaves are becoming more frequent and severe globally. Heat is associated with increases in emergency department (ED) volumes and higher morbidity for a range of chronic conditions. We describe how temperature impacts ED arrivals at different acuity levels.

Methods: We obtained time-series records for daily ED arrivals stratified by Emergency Severity Index (ESI) from 2010 – 2019 from hospital records. Wet-bulb temperature was the exposure of interest; analysis was controlled for precipitation, snow, wind speed, day of week, and federal holidays. We fitted a Poisson model for each ESI category and estimated the association between temperature and ED arrival acuity with a distributed lag non-linear model with three days of lag to account for delayed health effects of temperature.

Results: We analyzed data for 3,652 days totaling 556,663 arrivals between 2010 – 2019. At lag 0, lower temperatures were associated with a reduced relative risk of arrival to the ED for ESI 2, ESI 3, and total arrivals. At higher temperatures, ESI 2 and ESI 3 showed an increased relative risk of arrival (wet-bulb exposure of 25°C at 0-day lag: ESI 2 RR = 1.06 [1.02–1.10]; ESI 3 RR = 1.04 [1.01-1.07]). While not statistically significant, ESI 1 exhibited a subtle increase in arrivals at the highest temperatures while ESI 4 & 5 displayed a subtle decrease in relative risk of arrivals under these conditions.

Conclusion: Extremes of temperature, particularly heat, appear to affect ED arrivals differently across different acuity levels. Medium- to higher-acuity presentations appear to be more responsive to heat, with a statistically significant increase in ED presentations on days with the highest heat burden. The highest acuity presentations became numerically but not statistically more frequent on days with the highest heat burden, while the lowest acuity presentations decreased numerically but not statistically in these conditions.

Background. The attitudes and engagement of health care staff with climate and social factors relevant to health are increasingly important as climate change intensifies. Methods. We conducted secondary analysis of 296 survey responses from employees at health care safety net clinics and health centers across 48 U.S. states and territories to ascertain perception and engagement with climate risks and social determinants of health (SDOH) in their practices. Results. Most participants demonstrated understanding, confidence, and engagement with climate risks and SDOH. Participants scored higher on SDOH metrics than climate metrics. There was moderate correlation between engagement with SDOH and engagement with climate-related health issues across domains of knowledge, confidence, perceived importance, and consultation with patients. Conclusions. Health care workers who engaged with SDOH in their practice were also more likely to consult with patients on climate-related health impacts, suggesting that climate exposures could be integrated into clinical care as SDOH are.

Electronic health records are often extracted and combined with environmental data to conduct research or public health surveillance. However, to date, electronic health record systems do not integrate environmental data to aid real-time decisions that could mitigate the health impacts of environmental hazards, including the impacts of climate change. Pursuing this goal requires the enhancement of health record systems and the modification of financial incentives driving healthcare innovation and delivery.

Variable emergency department (ED) volumes contribute to staffing challenges. Weather may impact ED arrival patterns. Enhancing prediction of arrivals based on weather conditions may be useful for operational planning, including adaptation to climate change. In this retrospective analysis of ED arrivals from an urban teaching hospital in the Northeast US from 2010 to 2019, two linear regression models were developed to predict daily arrival totals. The base model utilized calendar variables and a 28-day rolling average of daily arrival totals. The second model added weather variables. Models were tested for overfitting using training and test datasets, and residuals were plotted. Addition of weather variables to the model increased adjusted R-squared (0.418 to 0.483). Effect estimates and 95% confidence intervals for predictor variables in the final model were scaled to the mean daily arrival total (152.7) to facilitate interpretation. Monday was predictive of the most arrivals (+ 23.1%, CI + 22.0% to + 24.2%), relative to Sunday (reference). Holidays were associated with fewer arrivals (− 14.2%, CI − 15.9% to − 12.4%). Inclement weather was associated with fewer arrivals. Increases in the relative maximum daily temperature were associated with increases in arrivals. The effect of temperature varied across seasons. Inclusion of weather variables improved predictive value of a model of daily ED arrivals in this single-site, retrospective analysis. Rain, snow, and wind were associated with reduced arrivals, while warmer temperatures relative to historical averages were associated with increased arrivals. Inclusion of weather variables into models of ED utilization may support improved operational decision-making.

Introduction

Climate change leads to an increasing risk of heat exposure and pre-emptive alerting to patients may be an important intervention to limit health risks related to heat. The process of providing counseling and resources related to impending dangerous heat in an ambulatory clinic setting has not been described. In this pilot project utilizing an electronic heat alert system, we describe the implementation of a clinic-level protocol for providing alert-based heat health information and proactively educating rheumatology patients in an ambulatory setting on dangerous heat conditions.

Methods

Physicians, nurses and medical assistants received electronic notifications of dangerous heat forecasts via a external heat alert system (Realtime Climate Heat Risk). Participating staff completed surveys at the midpoint and end of the heat season. The primary endpoint was a self-reported estimate of the percentage of patients engaged regarding heat safety on days where heat alerts were issued.

Results

There were 4 heat alert days during the study period. Half of participating staff members reported they had engaged 50 % or more of their patients on this topic. Self-reported levels of engagement by medical assistants were significantly higher than those of physicians and nurses, (W = 4.5, p-value = 0.036).

Conclusions

Heat and other environmental exposures present risks to patients as the effects of climate change worsen. Heat alerts may help staff address health risks with their patients. This pilot study demonstrates that an external heat alert system can be implemented utilizing providers of different skill levels and at all points of patient interaction in an ambulatory clinic setting.

This review examines healthcare system resilience to tropical cyclones through complementary frameworks of temporal phases (Before-During-After) and geographic contexts (Inside-Outside Impact Zone). The paper highlights how climate change is intensifying cyclone threats while demographic transitions create increasingly vulnerable patient populations dependent on continuous healthcare. Despite decreasing immediate mortality from cyclones, research reveals concerning increases in delayed morbidity and mortality due to disrupted healthcare access. Seven critical dimensions of healthcare resilience are identified: maintaining continuity of care for vulnerable populations, transitioning from reactive response to proactive resilience, strategic resource prioritization, adapting to climate change, integrating efforts across phases and zones, ensuring health equity, and addressing research gaps. A tiered approach to strengthening resilience is proposed, from immediate low-resource actions to long-term structural investments. The review emphasizes that healthcare systems must transform from reactive disaster response to proactive resilience strategies to protect vulnerable populations in an increasingly turbulent future climate.