Hospital Readmissions Following Early Discharge in Anticipation of a Hospital Evacuation: Hurricane Sandy and the US Department of Veterans Affairs

Introduction: Approximately 6,300 patients were evacuated from 37 healthcare facilities in New York City (NYC) because of “Superstorm Sandy.” Deciding whether to discharge patients early or evacuate them in anticipation of a disaster is challenging. During disasters, both hospitals that are evacuating patients and hospitals that anticipate receiving them typically utilize early discharge strategies to decrease the number of patients that must be evacuated and provide capacity to receive incoming patients. The impact of these early discharges on patient health is unclear.

Methods: We used data from the Department of Veterans Affairs (VA) to examine 30-day, all-cause hospital readmissions of patients who were discharged early from VA hospitals in NYC because of Hurricane Sandy.

Results: At Manhattan, 8 of 45 patients who were discharged on the day of the evacuation were readmitted to a VA hospital within 30 days. Similarly, at the receiving hospitals, 3 of 12 patients at Brooklyn and 2 of 9 patients at the Bronx were readmitted within 30 days of discharge. More than half of the readmitted patients were behavioral health patients.

Discussion & Conclusion: Early discharge instead of evacuation may result in hospital readmission, and places patients at increased risk of morbidity and mortality. Nevertheless, the reported readmission rates are similar to national and regional non-disaster readmission rates, suggesting that relatively safe care transitions during disasters may be feasible, at least in an integrated delivery system. Patients with significant behavioral health needs are at increased risk for readmission during a disaster.