...net, are overcrowded and typically lack adequate resources. In addition, the increasing number of uninsured patients requiring care and an aging population further aggravate the situation. In 1998, more than 93 percent of the 1.47 million hospitalized self-pay patients were admitted through EDs (National Center for Health Statistics 1998).

Hospitals are struggling to deal with challenges once thought to be "ED issues," and they now realize these are systemic issues that are not directly attributable to a single department. Of greatest significance at this time is the large number of admitted patients being held in the ED while waiting for an inpatient bed to become available, which contributes to overcrowding. In addition, longer turnaround times for ancillary departments, such as radiology and clinical laboratories, further increase an already exorbitant ED length of stay. Insufficient bed capacity in a hospital creates patient bottlenecks in the ED, which can result in an increased number of patients who leave without being seen or treated. Now more than ever, there is a greater emphasis on preventing the use of the ED in nonemergent situations in hopes that this will mitigate the aforementioned challenges.

It has been informally hypothesized that inclement weather conditions result in reduced ED utilization because nonemergent patients opt to delay or not seek treatment at all in such conditions. The premise and hypothesis for this Fellow Project is that the presence of inclement weather (which later is defined using several criteria) will result in reduced ED utilization, thereby lending support to the conclusion that EDs suffer from nonemergent patient utilization.

METHOD SUMMARY

To measure the relationship between weather conditions and ED utilization, an analysis of daily ED data from a major tertiary-care teaching hospital in New York City was conducted from January 2001 through June 2004 (42 months, encompassing 1,316 days). Daily volumes were assessed, and mean values for average daily volume were calculated for each month.

From this, a calculation was performed to identify the variance between the daily ED patient volume and the mean patient volume for that individual month. Once this variance was quantified, an additional analysis was performed to attribute weather patterns to the variances and determine how specific patterns affected ED utilization.

A second variable that was analyzed against the daily weather conditions was the percent of all ED patients who were admitted for each date (known as the ED admission rate). This variable can further support or refute the hypothesis that poor weather influences a patient's decision to visit an ED. If the hypothesis is true, then one would expect to see a higher admission rate on days that exhibited poor weather conditions, because on those days only the "true" emergencies would conceivably present to the ED.

Weather data were obtained from the National Climatic Data Center (NCDC) website (www.ncdc.noaa.gov), which is the world's largest active archive of weather data. Data were obtained from the NCDC for observed conditions at the weather station in Central Park, New York City, which is approximately 3.3 miles away from the hospital's ED.

To establish a specific scope for this analysis, eight distinct measures were created using the NCDC data set. The measures were snow accumulation, daily departure from normal temperature, selected numeric values of daily average temperatures that fell in a specific range (below freezing--32[degrees]F below 25[degrees]F and below 15[degrees]F), days with any type of rain, days with any type of snow, and days with any type of rain or snow. For a detailed description of all...

NOTE: All illustrations and photos have been removed from this article.



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