Elsevier

Annals of Emergency Medicine

Volume 74, Issue 3, September 2019, Pages 325-331
Annals of Emergency Medicine

Health policy/review article
Freestanding Emergency Departments: What Is Their Role in Emergency Care?

https://doi.org/10.1016/j.annemergmed.2019.03.018Get rights and content

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.

Introduction

Freestanding emergency departments (EDs) are changing the landscape of emergency care in the United States and are being considered around the world.1 These facilities provide emergency care to patients while remaining physically distinct from a hospital, unlike a traditional hospital-based ED. Because they continue to expand, freestanding EDs have begun to receive more research interest and regulatory evaluation.

These facilities may help alleviate the stress faced by the emergency care system in this country. With ED visits increasing from 123 million to almost 137 million from 2008 to 2015,2, 3 freestanding EDs may help address crowding at traditional hospital-based EDs and improve access to care.4 By siphoning lower-acuity patients, freestanding EDs may increase the efficiency of hospital-based EDs.1 Work by Pines5 suggested that freestanding EDs can also play a role in providing emergency care during natural disasters such as hurricanes.5 They may be able to improve access to care for trauma patients in rural areas,6 as well as maintain access to all types of emergency care in areas where critical access hospitals are closing because of financial problems.7

Freestanding EDs, however, face their fair share of criticisms. Many individuals worry that patients are mistaking freestanding EDs for cheaper urgent care centers, that freestanding EDs may be misleading patients about their insurance network status, and that these facilities may be exacerbating increasing medical costs.8, 9, 10, 11, 12 This article will review the current literature on freestanding EDs, providing an overview of the current state of these facilities and their effects on traditional hospital-based EDs, and whether current freestanding EDs work to address the need for improved quality and access to emergency care services.

Section snippets

Materials and Methods

We used a librarian-assisted review, searching the PubMed database with the search terms “freestanding emergency department,” “freestanding emergency departments,” “freestanding emergency center,” “freestanding emergency centers,” “FSED,” “FSEDs,” “FEC,” “FECs,” or “freestanding emergency” for articles in English published after 2000. This search resulted in 1,731 unique articles. A.J.A. reviewed the titles of these articles to exclude those that were not related to the care provided by

What are Freestanding Emergency Departments?

Currently, individual states regulate freestanding EDs. These regulations, if present at all, vary greatly from state to state and no national standards exist to which freestanding EDs must adhere. The American College of Emergency Physicians (ACEP) has, however, produced a policy statement with recommendations for criteria that it believes all freestanding EDs should meet.13 According to ACEP, facilities should be available to the public 24 hours a day, 7 days a week, 365 days per year; be

Limitations

Our review of the literature has some important limitations. Because state licensing regulations govern freestanding ED existence, variation in those regulations may have a large influence on freestanding ED characteristics from state to state. One particularly important variation is whether a state will allow only off-campus EDs (such as Ohio) or will allow independent freestanding emergency centers to operate as well (such as Texas). Another important consideration is whether a state has a

Discussion

Freestanding EDs have a role to play in the health care system. They have been used effectively to maintain access to care in rural areas where critical-access hospitals are difficult to maintain financially, such as in Arizona.46 They can also be used to maintain access to emergency care in communities where hospitals are consolidating, such as in Illinois.47 As referenced above, they demonstrate higher patient satisfaction than hospital-based EDs.19 Physicians who work at freestanding EDs

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  • Cited by (0)

    Supervising editor: Daniel A. Handel, MD, MBA. Specific detailed information about possible conflict of interest for individual editors is available at https://www.annemergmed.com/editors.

    Author contributions: CD conceived the study. CD and AA collected and analyzed studies. AA drafted the manuscript and both authors contributed to revisions. CD takes overall responsibility for the paper.

    All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Dark reports former stock ownership in Sturm Ruger and Adeptus and current stock ownership in GlaxoSmithKline and Teledoc. He also reports receiving past sponsorship for the PolicyRx Annual Symposium from Community Health Choice, Schumacher Clinical Partners, and HealthCorps.

    A podcast for this article is available at www.annemergmed.com.

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