Free Standing Emergency Rooms

akulahawkRN, ADN, RN, EMT-P · Jan 29, 2014

Are you referring to an urgent care "doc in a box" type place or are you referring to a Basic ED that isn't connected to an acute care facility but would have similar initial capability as if it were?

If it's the latter, I can see that in certain circumstances, it could be a good thing for outlying communities, but... in the former, quality can vary as can the hours of operation...

Elle23 · Jan 29, 2014

They are actual emergency rooms/ centers (I would give some names, but it would probably reveal my location!)

I was wondering if they were just the ER equivalents of doc-in-the-boxes.

From what I have read on a few websites, they claim capability to handle any emergency.

We have one about 5 minutes from our house. The nearest hospital is about a 30 minute drive (due to the miserable traffic conditions where I live).

CrunchRN, ADN, RN · Jan 29, 2014

We have them and they have CT and US and ER nurses and can do so much more than urgent care. It always seems deserted when I drive by on my commute. However, we had to go there one night about 7pm and were the only ones there. When we left every room was full and more.

Esme12, ASN, BSN, RN · Jan 29, 2014

These are popular in some areas more than others due to state law....some states require that the freestanding ER's have a hospital affiliation. They are like the surgi-centers that popped up so the MD's can have a corner on the profits. They are full functioning emergency departments and your insurance will cover them...however...only at the going rate. These places tend to be more expensive and charge "facilities" charges that are NOT reimbursable through insurance companies. They treat and transfer when you need to be admitted. They have lovely waiting rooms and a hotel lobby like atmosphere...the wait times are usually significantly less.

Medical entrepreneurs are remaking the emergency room experience. They're pulling the emergency room out of the hospital and planting it in the strip mall.
It's called a "," and some 400 of them have opened across the country in the past four years.
The trend is hot around Houston, where there are already 41 free-standing ERs and 10 more in the works.
"I think these emergency medical centers are springing up like Texas wildflowers in the springtime," says , a health economist at Rice University in Houston. "It's really amazing."
Some of the new facilities are owned by hospitals, but the majority are owned by for-profit companies. Ho says they may offer excellent care, but they're also chasing profits.
"They are usually set up in places where there are high-income patients who are well-insured and who want to see someone quickly," says Ho. They're not being built in poor neighborhoods, rural communities or areas with lots of uninsured people.

Patients Can Pay A High Price For ER Convenience : Shots - Health News : NPR

ChristineN, BSN, RN · Jan 29, 2014

We have them popping up in my area too. I have never been to one, but they are affiliated with a hospital.

CrunchRN, ADN, RN · Jan 29, 2014

Ours are non-affiliated (the one I went to). They were actually very impressive. Our insurance covered it except a 75 buck copay. However, insurance changed and they are no longer covered. I wish they were because it was close and fast and they really had everything we needed.

Of course if it was something way serious I would want a real ED at the hospital.

HLLoNuRSe · Jan 29, 2014

I, too, live in a large metropolitan area. I also currently work in an ER and an immediate care. The immediate care is affiliated with a large medical network/group and not a hospital. We are very busy. We see approximately 40-50 patients per day (we are open 10-10). We are staffed with one doctor, one nurse, and three to four paramedics on a typical day. We have eight rooms. We have full lab and imaging on site (xray, CT, MRI, and ultrasound) we have the capability to directly admit patients to near by hospitals. We do also have patients that we transport to the ER.

I would best describe us as a middle ground between a doctors office and an ER. We only charge for an office visit. Obviously, there are charges for services provided too. But it is way less than a trip to the ER.

jgamom · Jan 29, 2014

The ones I know of that are affiliated with hospitals are actual emergency rooms that are staffed by very experienced nurses and doctors. In fact, my old hospital has a few. I worked in the hospital's main ED. Only the most experienced and autonomous nurses where allowed to transfer to the new sites. They are capable of doing all work-up and can deal with probably 95% of what comes in the door. They would either airlift out or transport the higher end needs (i.e. STEMI's to cath lab, traumas, etc.). They could even bypass the home ED by writing inpatient orders and having the patient transported directly to the appropriate unit at the main hospital. They really relieve the heavy waits at the main campus.

The reason that some of the hospitals choose to open these remote facilities is that they want to expand and build a new hospital in that area. State regulations only allow for a certain number of "approved" beds for inpatient use. This is a strategy to get a foothold in the area where they'd like to expand but can't in the short-term. This way they already own the land and have a customer base when more beds are approved. It's actually quite smart on their part. They have the upper hand on the competition.

Ruby Vee, BSN · Jan 29, 2014

I am curious what your opinions are of free standing emergency rooms?
Where I live (suburb of a large metro area), they seem to be popping up on every corner. And they always appear empty....not a car or person in sight.
Have you ever worked in one or been to one as a patient? How do they differ from ERs at the hospital (regarding treatment/ testing capacity)?
Would you go to one in a true emergency if it were much closer than the nearest hospital?

If you're referring to a "Doc In A Box" or an "Urgent Care Center," I've used them. Our insurance covers the entire visit with a $15 co-pay for an urgent care center, but the co-pay for an ER visit is $150. The ones I've used have lab capability for standard tests and are able to send others out. They have X-ray and ECG capability. I did use one once for chest pain (I was right next door when the chest pain started) and was horrified that they didn't seem to have any discernable chest pain protocol. They did send me to the ER via ambulance, AFTER they did a chest X ray and dithered for quite some time -- no O2, no Nitro or morphine, no ECG -- and thankfully, I ruled out.

On the other hand, when I had a close encounter with an unidentified submerged object and needed stitches on July 4, there was hardly anyone there. I was in and out within an hour, got my stitches, a tetorifice shot and a prescription for antibiotics. (Wasn't a very clean body of water.) When I had an allergic reaction to something or other and broke out in head to toe hives, they were right on top of a script for Vistaril and a note for work. UTIs on a weekend when my PCP is unavailable, an ear infection, etc. they're great.

In a true emergency, though, call 911, even if you're standing in front of the Urgent Care Center.

CrunchRN, ADN, RN · Jan 29, 2014

Ruby,

OP is talking about actual free-standing ED's. The ones that are popping up here in the last 3 years are unaffiliated with hospitals. They have ER docs, ER nurses, and most ancillaries including CT. They have CP protocols etc.

They are not at all just like the old urgent care "doc in a box".

They advertise they can handle and at least start care for everything a traditional ED handles and then they ship you out to the hospital. They put them in suburban neighborhoods that do not have hospitals close by.

They are sprouting like mushrooms here in North Texas.

HLLoNuRSe · Jan 29, 2014

P.S. all of us that work at my immediate care all have years of ER experience.