Freestanding Emergency Departments and the Trauma Patient

Simon, Erin L.; Medepalli, Kantha; Williams, Carolyn J.; Yocum, Andrew; Abrams, Eric; Griffin, Gregory; Orlik, Kseniya

doi:10.1016/j.jemermed.2014.09.005

Cited by 8 publications

(4 citation statements)

References 10 publications

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“…ft.) (Provost, 2019). In addition, hospitals may have to spend additional resources on hiring new office managers, clinicians, and other support staff as well (Williams et al, 2015). In other words, initial startup costs for new FSEDs are likely to be high.…”

Section: Hypotheses and Research Modelmentioning

confidence: 99%

“…(Provost, 2019). On the other hand, however, FSEDs do not treat trauma patients (they may evaluate and stabilize trauma patients, but then transfer them to hospital‐based EDs; Simon et al., 2015). Therefore, patients seen at FSEDs tend to have lower acuity and need less treatment than those that are seen at traditional EDs (Pines et al., 2018; Simon et al., 2018) because of which, FSEDs may potentially cost less to operate on a recurrent basis, as compared to traditional EDs.…”

Section: Introductionmentioning

confidence: 99%

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On the creation of free‐standing emergency departments by hospitals—Some insights

et al. 2022

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Emergency departments (EDs) are an integral part of many acute care hospitals. Recently, however, hospitals have been increasingly experimenting with a new type of ED, for example, freestanding emergency departments (FSEDs). These are EDs that are physically separate from acute care hospitals but provide many of the same services provided by traditional EDs. Because of this geographic decoupling between the parent hospital and the FSED, hospitals can potentially reach out and provide services to user groups that may otherwise have been located too far away to serve. While this sounds good in theory, some have argued that FSEDs often get located in geographically proximate markets, rather than truly underserved areas, thereby exacerbating health care inequities. The current study investigates hospitals setting up FSEDs and examines their accrued business impacts to the parent hospital. By gathering a panel dataset covering several years of FSED openings and hospital performance, we examine how market share and operating margins of parent hospitals are impacted when they set up FSEDs. Results indicate that while there are some positive performance implications for hospitals who create FSEDs, a majority of these benefits are seen only for the first FSED created. We contend that this finding is driven by the fact that FSEDs are unlikely to be able to truly reach out to untapped populations, on account of their inherent nature. In conclusion, we question whether FSEDs are indeed a scalable approach to increasing health care access and reach.

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Section: Hypotheses and Research Modelmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

On the creation of free‐standing emergency departments by hospitals—Some insights

et al. 2022

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“…23 Burke et al 21 found that freestanding ED patients were significantly more likely to be non-Hispanic white (86% versus 60%), whereas hospital-based ED patients were significantly more likely to be unemployed (51% versus 33%). Simon et al 26 found that of all trauma patients who required transfer at 2 Ohio off-campus EDs during a 4.5-year period, greater than 97% were white. Another study of patients admitted to the ICU from a hospital-based ED or from an associated off-campus ED found that patients admitted from an off-campus ED were 89.6% white compared with 70.8% of the patients admitted from the hospital-based ED.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Freestanding Emergency Departments: What Is Their Role in Emergency Care?

Alexander

Dark

2019

Annals of Emergency Medicine

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Freestanding emergency departments (EDs), health care facilities that offer emergency care without being physically attached to a hospital, are becoming more common throughout the United States. Many individuals propose that these facilities can help alleviate the stress our current emergency care system faces and provide care to people with limited access to traditional hospital-based EDs. We reviewed the current literature on freestanding EDs to investigate whether these facilities are meeting those goals. We found that although they provide care that is generally similar in quality and cost to that of hospital-based EDs, freestanding EDs tend to cater to a more affluent patient population that already has access to health care instead of expanding care to underserved areas. This, coupled with a fragmented system of state-by-state regulation, leads us to recommend implementing more uniform licensing criteria from state to state, encouraging freestanding EDs to operate in more rural and underserved areas, and increasing price transparency.

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“…2 However, as Simon et al recently observed, research involving FEDS has yet to yield a precise definition. 17 When they first opened in the 1960s and until the 21st century, FEDs were located in rural and outer-ring suburban areas 18 ; only recently have facilities opened, and not always successfully, in urban settings. 6 Increasing numbers of FEDs also reflect an effort to address in-hospital emergency room overcrowding, an issue of importance for clinical outcomes.…”

Section: Background and Demographicsmentioning

confidence: 99%

Simulation for Operational Readiness in a New Freestanding Emergency Department

et al. 2016

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Summary StatementSimulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together. Methods throughout the preoperational term included predominantly hands-on skills review, high-fidelity simulation, and simulation with standardized patients. We also used simulation during instruction in disaster preparedness, sexual assault forensics, and community outreach. Our program culminated with 2 days of in-situ simulation deployed in simultaneous and overlapping timeframes to challenge system response capabilities, resilience, and flexibility; this work revealed latent safety threats, lapses in communication, issues of intake procedure and patient flow, and the persistence of inapt or inapplicable mental models in responding to clinical emergencies.

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Freestanding Emergency Departments and the Trauma Patient

Cited by 8 publications

References 10 publications

On the creation of free‐standing emergency departments by hospitals—Some insights

On the creation of free‐standing emergency departments by hospitals—Some insights

Freestanding Emergency Departments: What Is Their Role in Emergency Care?

Simulation for Operational Readiness in a New Freestanding Emergency Department

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