What is a Freestanding Emergency Department? Definitions Differ Across Major United States Data Sources.

Darya Herscovici,Ashley Sullivan,Krislyn Boggs,Carlos Camargo Jr

doi:10.5811/westjem.2020.3.46001

Darya Herscovici, Ashley Sullivan + Show 2 more

Open Access

https://doi.org/10.5811/westjem.2020.3.46001

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Abstract

IntroductionDespite the growing number of freestanding emergency departments (FSED) in the United States (US), FSED definitions differ across major US data sources of healthcare facilities and use. We compare these sources and propose a universal definition of FSED (and its two major types) to improve communications regarding these facilities and their patients.MethodsWe collected definitions of FSEDs from 11 national data sources using their websites, email, and telephone communications. For each source, we asked how they define FSEDs, whether being open 24/7 is a requirement to be called an ED, and whether they maintain a dataset of FSEDs.ResultsDefinitions varied across the data sources. All sources recognize FSEDs in their definitions, regardless of type; only one (the National Health Intervew Survey) does not differentiate them from other EDs. Five of the 11 sources (45%) omit autonomous FSEDs from their definitions and do not separately identify satellite FSEDs from their affiliated hospitals. One source does separately identify satellite FSEDs from their affiliated hospitals, but also omits autonomous FSEDs. Furthermore, three of the 11 sources (27%) do not require being open 24/7, while all others (73%) employ this criterion. Six of the 11 (55%) maintain datasets of FSEDs using their definition.ConclusionAs FSEDs continue to change the landscape of emergency care, it is important that they also be represented in national ED data sources. The current differences in the definition of an FSED make it difficult to provide accurate and longitudinal analysis for these facilities and patients who receive services at these facilities. We propose a universal definition of FSEDs as described by both the American College of Emergency Physicians and the National Emergency Department Inventory. Implementing a standard definition would facilitate a more accurate representation of FSEDs in national data sources and enhance ongoing efforts to improve the quality of emergency care delivered in FSEDs.

Highlights

Despite the growing number of freestanding emergency departments (FSED) in the United States (US), FSED definitions differ across major US data sources of healthcare facilities and use
As FSEDs continue to change the landscape of emergency care, it is important that they be represented in national ED data sources
We propose a universal definition of FSEDs as described by both the American College of Emergency Physicians and the National Emergency Department Inventory

Summary

Introduction

Despite the growing number of freestanding emergency departments (FSED) in the United States (US), FSED definitions differ across major US data sources of healthcare facilities and use. We compare these sources and propose a universal definition of FSED (and its two major types) to improve communications regarding these facilities and their patients. Of all US EDs were FSEDs.[3] In 2016, the Medicare Payment Advisory Commission (MedPAC) reported that FSEDs accounted for 11% (566/5,200) of all EDs nationwide.[4].

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