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• W2530031117 abstract "While emergency departments (EDs) are chiefly focused on the patients presenting to their facility, they can also influence the response of the greater community in the out-of-hospital emergency setting. Specifically, for emergencies like ischemic stroke (iCVA), opioid overdose, and cardiac arrest, where early detection and correct bystander response can make crucial, life-saving differences in the field, EDs can teach communities about recognition of stroke-like symptoms, delivery of bystander naloxone, and administration of bystander cardiopulmonary resuscitation (CPR). To identify areas where community-based interventions would be most useful, we geospatially analyzed the home addresses of over 300,000 visits to the ED of a single tertiary care center and identified hotspots for emergency visits related to iCVA, opioid overdose, and cardiac arrest. Data on the self-reported home address, chief complaint, discharge diagnosis, and basic demographics were recorded as part of each visit for all patients who presented between 7/1/2012 and 6/30/2015 to the ED at The Massachusetts General Hospital (MGH) in Boston, MA. Visits were geocoded by US Census Tract using the United States Census Bureau’s Census Geocoder (geocoding.geo.census.gov). Geospatial analysis was performed with QGIS (www.qgis.org). Visits related to a specific emergency like iCVA were identified by scanning chief complaints and discharge diagnoses for a priori selected terms using partial string matching implemented in R (r-project.org). Hotspots were identified using the Jenks Natural Breaks method and normalized to population levels from the 2010 US Census. Out of 313,085 total visits, we considered 286,555 visits from addresses in Massachusetts, 250,073 (87%) of which were geocoded to the census tract level. Of these visits, we selected 2,401 visits for known or potential iCVA, 3,200 visits related to opioid overdose, and 3,343 visits related to cardiac arrest. For iCVA or cardiac arrests, patients were significantly older than average, while for opioid overdose they were significantly younger. Hotspot analyses for each disease process identified multiple potential hotspots in and around Boston. After adjusting for population data, significant hotspots for iCVA were identified within Winthrop and Chelsea, two neighborhoods just outside Boston, and significant hotspots for both opioid overdose and cardiac arrest were identified within Charlestown, a neighborhood in the North of Boston. Here we selected three clusters of visits for disease processes amenable to community-based teaching and used geospatial analyses of patients’ home addresses to identify hotspots in specific neighborhoods around our ED in Boston, MA. While further study is needed to explore why these hotspots exist where they do, immediate action can now be taken by our ED to target necessary teaching in the recognition of stroke-like symptoms, delivery of bystander naloxone, and administration of bystander CPR to these hotspot communities. Ultimately, identifying these hotspots is the first step toward improving out-of-hospital community response and potentially decreasing morbidity and mortality of iCVA, opioid overdose, and cardiac arrest, and could further be used as a model for engaging communities in out-of-hospital response teaching in general." @default.
• W2530031117 created "2016-10-21" @default.
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• W2530031117 date "2016-10-01" @default.
• W2530031117 modified "2023-10-14" @default.
• W2530031117 title "169 Geospatial Analysis of Patient’s Home Addresses to Facilitate Out-of-Hospital Community Response" @default.
• W2530031117 doi "https://doi.org/10.1016/j.annemergmed.2016.08.182" @default.
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