Clinical differences between visits to adult freestanding and hospital-based emergency departments



      Compare clinical characteristics for adult visits to freestanding emergency departments (FEDs) and a hospital-based ED (HBED).


      Electronic health records were collected on adult ED visits from 7/1/14 to 6/30/15 from three FEDs and one level 1 trauma tertiary care HBED.


      There were 55,909 HBED visits; 44,108 FED visits. The FED population was slightly more female (61% vs 57%), younger (48 vs 46 years), white (86% vs 60%), and employed (67% vs 49%). A higher percent of FED visits had private insurance (43% vs 20%); a lower percent had Medicaid (25% vs 42%) and Medicare (23% vs 30%). The top three presenting problems were the same at the HBED and FEDs, but the order differed: gastrointestinal (HBED 19% vs FED 18%), cardiorespiratory (18% vs 16%), injury-pain-swelling of extremity (14% vs 17%). Differences were seen in primary ICD9 codes. One quarter of FED visits and only 18% of HBED visits were for injury/poisoning. A higher percent of FED visits were for respiratory diseases (12% vs 9%) but a lower percent were for circulatory system diseases (7% vs 11%) and visits for mental illness (2% vs 6%). Nearly 30% of HBED visits resulted in admission, compared to 8% of FED visits. ESI level differed significantly, with a lower percent of high acuity cases at FEDs (level 1: 0.1% vs 1.6%; level 2: 5% vs 26%).


      Differences were observed in clinical characteristics of adult HBED visits versus FEDs. Results of this study can help communities plan their emergency care system.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American College of Emergency Physicians
        Freestanding emergency departments.
        • Williams M.
        • Pfeffer M.
        Freestanding emergency departments: do they have a role in California?.
        • Sullivan A.F.
        • Bachireddy C.
        • Steptoe A.P.
        • et al.
        A profile of freestanding emergency departments in the United States, 2007.
        J Emerg Med. 2012; 43: 1175-1180
        • Schuur J.D.
        • Baker O.
        • Freshman J.
        • et al.
        Where do freestanding emergency departments choose to locate? A national inventory and geographic analysis in three states.
        Ann Emerg Med. July 2016;
        • Patidar N.
        • Weech-Maldonado R.
        • O'Connor S.J.
        • et al.
        Contextual factors associated with hospitals' decision to operate freestanding emergency departments.
        Health Care Manage Rev. June 2016;
        • Simon E.L.
        • Griffin P.L.
        • Jouriles N.J.
        The impact of two freestanding emergency departments on a tertiary care center.
        J Emerg Med. 2012; 43: 1127-1131
        • Simon E.L.
        • Kovacs M.
        • Jia Z.
        • et al.
        A comparison of acuity levels between 3 freestanding and a tertiary care ED.
        Am J Emerg Med. 2015; 33: 539-541
        • Simon E.L.
        • Griffin G.
        • Orlik K.
        • et al.
        Patient Insurance Profiles: a tertiary care compared to three freestanding emergency departments.
        J Emerg Med. 2016; 51: 466-470
        • U.S. Census Bureau, Population Division
        Annual estimates of the resident population: April 1, 2010 to July 1, 2015.
        Date: 2016
        Date accessed: February 27, 2017
        • Elixhauser A.
        • Steiner C.
        • Palmer L.
        Clinical Classifications Software (CCS) page.
        U.S. Agency for Healthcare Research and Quality
        Date accessed: June 5, 2017