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

      Abstract

      Objective

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

      Methods

      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.

      Results

      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%).

      Conclusion

      Differences were observed in clinical characteristics of adult HBED visits versus FEDs. Results of this study can help communities plan their emergency care system.
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      References

        • 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: 1175-1180https://doi.org/10.1016/j.jemermed.2012.02.078
        • 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; https://doi.org/10.1016/j.annemergmed.2016.05.019
        • 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; https://doi.org/10.1097/HMR.0000000000000113
        • 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: 1127-1131https://doi.org/10.1016/j.jemermed.2012.02.023
        • 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: 539-541https://doi.org/10.1016/j.ajem.2015.01.021
        • 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: 466-470https://doi.org/10.1016/j.jemermed.2016.05.058
        • U.S. Census Bureau, Population Division
        Annual estimates of the resident population: April 1, 2010 to July 1, 2015.
        https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml
        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
        https://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp
        Date accessed: June 5, 2017