Abstract
Background
Freestanding emergency departments (FEDs) represent over 10% of emergency departments
(EDs) in the United States. Little is known about differences in encounter characteristics.
We compared ED length of stay (LOS) clinical demographics, method of arrival, acuity
level, and patient disposition for encounters to FEDs vs. hospital-based EDs (HBEDs).
Methods
A multi-center retrospective analysis was performed. Study sites included 6 FEDs and
13 HBEDs from 10/1/2017 to 9/30/2018. Data was abstracted from ED records and discharge
summary within the electronic health record. Descriptive statistics were reported
with prevalence (95% Confidence Interval [CI]) for categorical variables and mean
(standard deviation [SD]) for continuous variables. Multivariable linear regression
assessed the relationship between ED facility (FEDs vs. HBEDs) and ED length of stay
(LOS).
Results
1,263,297 encounters were analyzed. Mean ED LOS was shorter at FEDs (146.62 min (±97.04))
vs. HBED (249.70 min (+287.50)). Nine percent of FED encounters arrived via EMS vs.
21% at the HBEDs. FEDs saw 5.47% emergency severity index (ESI) level 2 vs. 13.76%
at the HBEDs. Medicaid and Medicare patients were more prevalent in HBEDs (64.2%)
than in FEDs (50.6%). FEDs admitted 13% of patients and HBEDs 27%. All results were
significant (p < 0.001). After adjusting for potential confounding variables, patients utilizing
FEDs had 16.2% shorter ED LOS vs. HBEDs (β = −0.18 [95% CI: −0.18 to −0.17]).
Conclusion
Overall ED LOS was significantly less for FED vs. HBED patients. Acuity level, insurance
status, method of arrival, and patient disposition were significantly different at
FEDs vs. HBEDs.
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:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Stand-alone emergency departments.http://www.medpac.gov/docs/default-source/reports/jun17_ch8.pdf?sfvrsn=0(Published June 15, 2017)Date accessed: June 19, 2018
- A comparison of care delivered in hospital-based and freestanding emergency departments.Acad Emerg Med. 2018; 25: 538-550https://doi.org/10.1111/acem.13381
- Mode of arrival to the emergency department of stroke patients in the United States.J Vasc Interv Neurol. 2008; 1: 83-86
- Patient-reported reasons for seeking emergency care at a freestanding emergency department compared to a hospital-based ED.Am J Emerg Med. 2018; 36: 1702-1704https://doi.org/10.1016/j.ajem.2018.01.062
- Acuity, treatment times, and patient experience in Freestanding Emergency Departments affiliated with academic institutions.Am J Emerg Med. 2018; 36: 139-141https://doi.org/10.1016/j.ajem.2017.07.004
- Annual estimates of the resident population: April 1, 2010 to July 1, 2017.https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmkDate accessed: August 2, 2018
- Are free-standing ER's a rip-off?.http://www.physicianspractice.com/medical-billing-collections/are-free-standing-ers-ripDate accessed: January 29, 2019
- US emergency department performance on wait time and length of visit.Ann Emerg Med. 2010; 55: 133-141https://doi.org/10.1016/j.annemergmed.2009.07.023
- Freestanding emergency departments: burgeoning trend may relieve crowding but may drain away paying patients.Ann Emerg Med. 2011; 57: A22-A24https://doi.org/10.1016/j.annemergmed.2010.11.014
- Children who leave the emergency department without being seen: why did they leave and what would make them stay?.Acta Med Port. 2018; 31: 109-114https://doi.org/10.20344/amp.9962
- 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
Article Info
Publication History
Published online: May 31, 2019
Accepted:
May 30,
2019
Received in revised form:
May 30,
2019
Received:
February 6,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc.
