Freestanding Emergency Rooms

1
Freestanding Emergency Rooms

• Jay Tate Duty
• HCAI 5313 Policy Brief

2
Access to Emergency Care

• As emergency rooms become overcrowded,
  freestanding Emergency Rooms emerge
• Many linked to acute care facilities for
  Inpatient Care
• With the exception of Trauma, these facilities
  offer the same services as Acute Care Hospitals
• Freestanding ERs have been in existence for 40
  years but have gained popularity as physician
  investment has become possible

3
Increased Utilization

• According to the Centers for Disease Control,
  hospital ED visits increased more than 20 percent
  in the last decade
• Current average wait time is 3 hours
• More than half the patients waiting 2 to 6 hours
• High utilization for primary care

4
Goals of Freestanding ERs

• Increasing market share in lucrative suburban
  markets
• Decreasing visits to crowded main hospital ERs
• Establishing presence in communities that will
  need acute care facilities in the long run
• Provide a service with a reduced wait time

5
Outpatient Oriented

• Most within 15 miles of a parent hospital
• Co-located next to
• Imaging Centers
• Medical Clinics
• Ambulatory Surgery Centers
• Outpatient Therapies

6
Quality Concerns

• Not having all specialties on-call under one roof
• No access to acute services such as Cath Lab or
  Operating Room
• Necessary for some patients to be transferred
• Accept ambulance service but EMS providers would
  have to discern proper level of care which is
  counterintuitive for Emergency Care
• Must operate 24/7 to maintain Emergency Room
  status

7
Regulations

• Same regulations as a hospital-based ER
• Physical Plant
• Occupancy
• Construction Requirements

8
Denton Regional Relationship

• Working with 3 former ER physicians to develop a
  satellite Emergency Room in a rapidly growing
  area 12 miles from main hospital campus
• Developed transfer agreement for patient with
  acute care needs
• Gives access to a growing suburban area with
  15,000 new rooftops that might otherwise go to
  competitor in Denton, Frisco or Plano

9
Denton Regional Relationship

• Next to Family Practice Clinic
• Timeshare Space for Specialists
• Includes Imaging and Pharmacy within Emergency
  Room complex
• 3 Inpatient Beds with 24/7 nursing services

10
Certifications

• JCAHO
• CLIA (lab certification)
• COLA (Clinical Laboratory Accreditation and
  Education)

11
Question for the Future

• Will the quality and practice will truly measure
  up to hospital-based EDs?
• Will these centers remain financially viable as
  emergency centers operating 24/7?
• Will the public respond by using this as a
  primary care setting?
• Will EMS services avoid this setting causing them
  to miss out on viable patients?