Effects of a Labor Dispute on a Hospital-Based Helicopter Air Ambulance Service's Volume and Destinations.

OBJECTIVE: In the United States, there are few unionized hospitals with air medical transport agencies. When labor disputes and strikes occur, information about the effect on helicopter air ambulances and critical care ground transport services is limited. For this study, a helicopter air ambulance and critical care ground transport agency's volume of transports was examined before, during, and after a strike and compared with volumes from the prior year. METHODS: This was a retrospective, descriptive comparative review of a unionized hospital's air ambulance and critical care mobile ground transport service records from March 28 to July 22, 2018 (control year, 872 transports) and March 28 to July 22, 2019 (strike year, 863 transports). RESULTS: Compared with the prior year, during the strike period alone, the volume of flight transports remained stable; however, there was a significant 31% loss in transports for time-critical diseases including trauma, stroke, and myocardial infarction. CONCLUSION: The unionized helicopter air ambulance experienced little change in overall volume, but there was a statistically and financially significant decline in flight transports for patients with time-critical diseases. When preparing for labor disputes, potential declines in the transportation of this population type should be considered, and future studies should look at patient and requesting agency preferences during strikes.

Emergency department disposition of non-neutropenic febrile patients with cancer.

OBJECTIVES: National data reveal that 60% of the 4.5 million annual emergency department (ED) visits by patients with cancer result in admission. Many of these visits are due to a febrile illness. Current literature provides limited guidance on how to treat non-neutropenic febrile ED patients. This study characterizes clinical outcomes of non-neutropenic febrile patients with cancer presenting to an academic, Comprehensive Cancer Center affiliated ED. METHODS: Retrospective chart review of 101 randomly selected adult patients with active cancer presenting with a chief complaint of fever or a documented fever in the ED and an absolute neutrophil count above 1000 between October 2015 and September 2016. Descriptive statistics were calculated. RESULTS: The primary malignancies represented were hematologic (24%), gastrointestinal (13%), head and neck (13%), and genitourinary (8%). Sixty-two percent were on chemotherapy, 15% on radiation therapy, and 12% were on targeted therapy. Severe illness outcomes occurred in 39% and 83% were admitted with a median length of stay of 4 days. Among admitted patients, 24% experienced a length of stay ≤2 days. A return visit to the ED or an in-system hospitalization within 7 days of the index visit occurred in 10% and death occurred within 7 days of the index visit in 4%. CONCLUSION: A majority of patients presenting to the ED with non-neutropenic fever are admitted (83%), of whom nearly a quarter experience a length of stay of ≤2 days with infrequent serious illness outcomes. Future efforts should focus on the development of risk stratification tools in this population to avoid potentially unnecessary hospitalizations.