Freestanding Emergency Centers Research Articles

The Positive Impact of Establishing an Internal Transfer Center

Health systems are facing greater pressures than ever before, with factors ranging from mergers and acquisitions and changing reimbursement models to capacity challenges and staffing shortages. A transfer center, where with 1 simple call from a referring physician, a decision to accept a critically ill patient can be made, placing them at the most appropriate level of care, the first time. Baptist Health in Jacksonville, Florida, went from an outsourced to an in-house center in 3 months—in the first 28 days alone, patient transfers increased from 900 to 1,500, growing to an average of 1,583 transfers per month.

Freestanding Emergency Departments Preferentially Locate In Areas With Higher Household Income.

Freestanding emergency departments (EDs) are a relatively novel phenomenon, and the epicenter of this movement is in Texas. Limited evidence exists about the communities in which freestanding EDs locate or the possible reasons behind location choice. We estimated logistic regressions to determine whether freestanding EDs in 2016 were more likely to be in areas of high demand or in those that could yield high profits. When we compared Public Use Microdata Areas that contained freestanding EDs and those that did not, we found that areas with such EDs had significantly higher household incomes. This finding was driven by the location choices of independent freestanding emergency centers and not by those of hospital-affiliated satellite emergency centers.

374 ST-Elevation Myocardial Infarction in Free-Standing Emergency Centers: Can Door-to-Balloon Times of Less Than 90 Minutes Be Achieved?

Patients with ST-elevation myocardial infarction (STEMI) identified in free-standing emergency centers (FSEC) present unique challenges in accomplishing time-based ACC/AHA recommended interventions not encountered by hospital-based emergency departments (HBED). Lack of on-site specialty services and geographic distance from a center capable of acute percutaneous coronary intervention contributes to the challenges. The ability to achieve door-to-balloon (d2B) time < 90 minutes in STEMI patients first identified at a free-standing emergency department mandates ED-directed coordination of rapid identification, efficient clinical care, preparation for percutaneous coronary intervention, and rapid transport directly to a percutaneous coronary intervention facility without reevaluation at a destination hospital-based emergency departments.

Influence of organizational components on the delivery of asthma care.

The documented growing morbidity, mortality, and disability from asthma indicate a failure in effective delivery of appropriate care. This article reviews how different components of organizational technology in hospitals, free-standing emergency centers, physician practices, prepaid groups, and schools may be linked to asthma care and asthma outcomes. A framework to address how practice patterns, risk factors, and outcomes relate to organizational characteristics, such as time orientation, uncertainty, available technology, standardization of work, specialization of work, coordination, and control strategies, is presented.

Emergency department patient 'dumping': an analysis of interhospital transfers to the Regional Medical Center at Memphis, Tennessee.

To study the extent and nature of transfers of emergency department (ED) patients because of inability to pay, we audited all telephone requests and actual patient transfers from private hospital EDs and their affiliated free-standing emergency centers to the ED of the Regional Medical Center at Memphis (the Med), a publicly subsidized hospital, between June 1 and August 31, 1986. Transfers to the Med's "special care" centers were assumed to represent tertiary care referrals and were excluded. During the 92-day study interval, ED physicians at the Med handled 190 telephone requests for transfer. Requesting physicians explicitly identified "no money" or "no insurance" as the primary reason for transfer in 89 per cent of 164 cases in which these data were recorded. Thirty-seven per cent of requests were refused; half were too unstable or required an intensive care unit (ICU) bed when none were available. One hundred forty-six transfers (55 per cent) arrived without prior telephone authorization, most by private automobile. Almost all transferred patients (91 per cent) were sent for primarily economic reasons. One out of four was found to be unstable on arrival by explicit clinical criteria. Eighty-two patients transferred for economic reasons (34 per cent) required emergency hospitalization and accounted for 564 bed days during a period of extreme inpatient crowding. Three patients died prior to discharge. Two had been transferred for primarily economic reasons.

Freestanding emergency centers and the health care of adolescents

We studied the nature of the visits of patients aged 11–20 year to three free-standing emergency centers (FECs) and compared the mean to the national studies of visits by this age group to pediatricians and family/general physician. Differences in sex distribution, diagonostic procedures, and diagnostic categories of the FECs emerged. Our results suggest that adolescents seek FECs care for reasons different than those prompting visits to the traditional physician's office.

The development and use of freestanding emergency centers: a review of the literature.

The development and use of freestanding emergency centers: a review of the literature.

Pharmaceutical services in freestanding emergency centers

Pharmaceutical services in freestanding emergency centers

The referral of patients from freestanding emergency centers to a hospital emergency department

This retrospective study is a review of patients referred from a network of eight freestanding emergency centers FECs to a hospital emergency department during January and February 1984. During that time, 17,387 patients were seen at the FECs. Sixty-three (0.36%) of these patients were referred to the base hospital, of which 28 (44%) were admitted and six (9.5%) were admitted to a critical care unit. Four of the six critical care admissions arrived by ambulance. One was unstable and required cardioversion in the ED. Of the patients discharged from the hospital 70% were satisfied with FEC and 97% with hospital treatment. Of admitted patients, 89% were satisfied with FEC and 100% were satisfied with hospital treatment. For a similar illness in the future, 23% of all patients would return to a FEC, 28% would go to a private practitioner, and 48% would go directly to a hospital.

Community perceptions of appropriate sources of emergency care

Two hundred eighteen residents in a suburban community northwest of Chicago were interviewed using standard telephone survey techniques. Respondents lived in an area served by two hospitals and two freestanding emergency centers (FECs) that had been in operation for three years prior to the survey. Those surveyed were asked to react to three common medical emergencies of graded levels of severity, small laceration, injured ankle, and myocardial infarction, to identify self-referral patterns of this community. Respondents were questioned about their knowledge and perception of the FECs and their hours of operation. Approximately 66.5% of the sample population was aware of the existence of these two centers. Fifty-four percent to 85.5% of respondents did not view these facilities as appropriate centers for the treatment of major emergencies. Only 58.3% (at 6:00 PM) and 63.3% (at 3:00 AM) of those surveyed would activate the emergency medical services system for a suspected myocardial infarction. Respondents made choices that would have delayed definitive care, including going to an FEC. Of those who thought they knew the hours of operation of the FECs, 65% believed these facilities were open 24 hours a day when, in fact, they were not.

Free-standing emergency centers and the ED

Free-standing emergency centers and the ED

Disposition of patients referred from freestanding emergency centers to a hospital Emergency Department

Disposition of patients referred from freestanding emergency centers to a hospital Emergency Department

Freestanding Emergency Centers: Regulation and Reimbursement

The freestanding emergency center, which combines the functions of a doctor's office and a hospital emergency room, has emerged as a new provider of health care. These centers have generated considerable controversy over their role in the health care market. Proponents argue that freestanding emergency centers reduce costs by providing care in a more efficient manner and cause other health care providers such as hospital emergency rooms to reduce costs and improve service. Opponents argue that the centers create an additional layer of health care which duplicates existing services and increases total health care costs. This Note examines the controversial issues of licensure, regulation and reimbursement. The Note concludes that freestanding emergency centers can help to reduce health care costs and discusses the steps that should be taken to aid centers in achieving this goal. reduce health care costs and discusses the steps that should be taken to

A survey of Washington state freestanding emergency centers

A survey was conducted of the known FECs in the state of Washington in 1982 to assess facility organization and staffing patterns, equipment available, types of services offered, overall morbidity, and community acceptance. The 15 facilities responding saw an average of 25.6 patients in a 12.5-hour day, seven days per week. None of the facilities encouraged or accepted critical ambulance cases, and only one accepted non-critical transport patients. Essentially all have ACLS-trained physicians and resuscitation equipment, but only 0.003% of the total patient census required this intervention. A majority of the facilities utilized the word "emergency" in their title, but none indicated that this caused confusion for their patients. By self-assessment, public acceptance has been overwhelmingly positive, while primary care and hospital emergency physicians have been cool to the concept.

Impact of freestanding emergency centers on hospital emergency department use

This study was conducted to determine whether hospital emergency department (ED) use has been affected by the presence of freestanding emergency centers (FECs) in hospitals' service areas. A sample of FECs was drawn and hospitals in their service areas identified. ED visits to those hospitals from 1970 to 1980 were compared with those of a comparison group of hospitals not studied. The presence of FECs did not lead to a decline in ED visits to hospitals in their service areas. The study documented that FECs are located near hospitals that are larger than average and that have busier EDs. Because of the relative newness of FEC development, future studies of this type should be conducted. This study could not answer the question of whether FECs caused the growth of hospital ED visits to slow. It did not attempt to measure the impact FECs have on private medical practices or determine whether FECs attract currently underserved patient groups.