Free Standing Emergency Rooms

[Elle23]

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?

[akulahawkRN, ADN, RN, EMT-P]

We don't have anything like that here, where I'm at. We just have "doc in the box" urgent cares and ED's that are physically attached to an acute care center. Personally, I would prefer that free standing EDs would be affiliated with a hospital and not completely unaffiliated like the urgent care "boxes" can be, and probably are. Another option would be to create a hospital consortium for the express purpose of having satellite EDs that can treat and transfer directly to any hospital, and take any insurance plan as if it's "in plan." This way it wouldn't matter who your insurance company is, if you get seen at a satellite ED, you're being seen by an authorized provider just as if you went to an in-plan hospital/ED.

The downside is that they'd be loss-leaders, but then again, transport distances would be shorter for rural areas (where it'd be ideal to put these anyway) and someone could show up, get triaged/screened, and either quickly referred to an appropriate provider or stabilized/transported/admitted quickly. Perhaps under that model, the rate of loss would be a LOT less and hopefully the burden on more urban/suburban facilities would be less as some of the traffic that goes to them from outlying areas would be diverted, or directly admitted, bypassing crowded EDs and perhaps making more efficient use of all regional facilities.

Just an idea...

[lamazeteacher]

My experiences going to "Urgent Care" places, have almost all been positive. The staff was welcoming, I got seen quickly and had appropriate care and explanations. One of them actually followed up afterward, to see if I was better, had taken prescribed meds, treatment(s), etc. As a retired Registered Nurse, I know when that type of setting is best, and I wouldn't go to one if I was having life threatening s&s that could require hospitalization or surgery. More education of the public in that regard is very necessary! I hate seeing screeching ambulances going there to pick up someone and take them to hospital!

I have been very disappointed by today's EDs! On one occasion, I went by ambulance (after my cellphone batterty was left uncharged overnight and I had no land line); and I couldn't summon help, due to extreme weakness. I knew I was prone to that, due to having severe bleeding gastric ulcers before, caused by taking Aleve for over a year. That delayed care for 6 hours, and after I gave a complete hx to the EMTs and they accurately told a nurse that (I heard it), I wasn't seen by any nurse, doctor, or anyone for 4 more hours!!!

When someone finally appeared to inquire why I was there, my vitals were taken. My daughter had responded to my call to her, after the battery on my cellphone was charged, but being timid, she hadn't asked anyone on staff to see me. It became too late for the determination by X-ray of my bleeding site.... I was kept in a very dark area under construction, to await admission to that hospital in the morning........ No lab tests were done until that happened, and 3 transfusions finally were given in the afternoon quite hastily, after my Hgb was finally seen to be 5!

Hospitalists there had just been hired. They clearly didn't have their "act" together!

Last year, I went to an ED on the west coast, in Torrance where the money just rolls in for new construction. Staffing there is pretty meager. So I waited 4 hours before being seen for dyspnea caused by profuse laryngeal swelling! I went there because I thought that a tracheotomy might be necessary. I'd been in anaphylactic shock before.... Once I was on a gurney, I received no other intervention. However I was asked to sit in a nearby chair after a while, so staff could perform a "rectal exam on another lady" whose gurney was hastily placed next to the one I'd vacated; and the curtains around that location concealed little. I was embarrassed for the staff's oblivion to embarrass that patient, and she was, well, just embarrassed. One nurse told me that her department is always overwhelmed on December 26!

[Nurse_cox]

I have worked in a free-standing ER. It had all the capabilities of an in-patient facility except admits had to be transferred to nearby facilities. The place I worked had CT, MRI, Ultrasound, diagnostic x-ray, a fast-track clinic(during certain times of day). It was associated with a bigger hospital. Excellent staff. We stayed busy.

[Esme12, ASN, BSN, RN]

These free standing ER are real ER's they have CT scanners and do anything a "real" emergency room does. They are licensed just like the ER is licensed that is attached to a hospital.

Free-Standing Emergency Rooms Causing Controversy

Critics say simple ERs create more demand and drive up costs

First Choice is a gleaming, stand-alone emergency room built like a drive-through dry cleaners, set in an affluent neighborhood to signal convenience to consumers - and to rake in profits for private investors.

There's no towering hospital attached at the back, no helicopter pad, delivery rooms or surgery suites. But a doctor is always here, they handle hangnails to heart attacks, and regulators allow First Choice to charge high ER prices no matter how trivial the ailment.

"The hospital ER system right now is overburdened," said Andrew Jordan, chief marketing officer for First Choice.

"We're the ultimate fix-it shop," senior vice president Heather Weimer said. "We want to fix you and send you up or down to the next level."

But critics say free-standing ERs are creating and distorting demand, not just filling it.

"What they're doing is driving up the cost of medical care," said Dr. Vince Markovchick, an emeritus professor of emergency medicine and author of the manual "Emergency Medicine Secrets." Free-standing ERs can charge four or five times what an urgent-care center or clinic charges for common problems such as stitches, abdominal pain or sprains.

For-profit ERs are siphoning patients with insurance from urban hospitals that need the money to subsidize charity care, Markovchick and others said.

"They play the numbers of being in the right ZIP code," said Dr. Richard Zane, emergency department chair at University of Colorado Hospital.

Zane said he expects First Choice to build up to five more ERs in Colorado, and other for-profit competitors will likely follow - none of them good for the system, he added.

This First Choice ER on Powers Boulevard is the inaugural outpost for a company that has blanketed Texas with the controversial concept and now has sights on Colorado. With 16 other ERs around Houston and Dallas, First Choice is also renovating a site in Arvada to open early next year.

These are run by fully board certified emergency physician groups and not attached to any hospital in most cases....depending on state law. They will give TPA and transport. They take strokes and will transfer for admission.

Stand-alone emergency rooms are a popular, but very expensive ...

Freestanding emergency departments | The hospital s new front door

Freestanding Emergency Rooms Continue Growth Across North Texas

Emergency Care, But Not At A Hospital - Kaiser Health News

[nursemeanie]

The free standing ER's in my area are left over from hospitals that shut down, but the state required them to leave the ER open. They transfer out patients needing admission or consults to appropriate facilities.

[Ruby Vee, BSN]

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.

Interesting. I never heard of such a thing. (Obviously.) Carry on!

[ADeks]

The free standing ER is affiliated with the main hospital I work for. It's actually more efficient. My main hospital "holds" tele/ICU/etc beds for this free standing ER. So here we are holding many patients at times but there are beds available for the admits from the free standing ER. We have an ongoing joke that if we need to be admitted we'll go through the free standing ER because we know the main hospital has beds held for them.

From my understanding our hospital/ company makes a lot of money from the free standing ER.

So much that a rival hospital is building their own to create more revenue/ business because ours has done so well.

To add our freestanding ER is not appropriate to bring stemi it stroke alerts since we will have to set up Transport to bring pt to main hospital. Of course they treat the walk-ins.

[Ruby Vee, BSN]

The free standing ER is affiliated with the main hospital I work for. It's actually more efficient. My main hospital "holds" tele/ICU/etc beds for this free standing ER. So here we are holding many patients at times but there are beds available for the admits from the free standing ER. We have an ongoing joke that if we need to be admitted we'll go through the free standing ER because we know the main hospital has beds held for them.

From my understanding our hospital/ company makes a lot of money from the free standing ER.

So much that a rival hospital is building their own to create more revenue/ business because ours has done so well.

To add our freestanding ER is not appropriate to bring stemi it stroke alerts since we will have to set up Transport to bring pt to main hospital. Of course they treat the walk-ins.

So is this free standing ER in a different part of town? Is that why it's free standing?

[FlyingScot, RN]

Our large urban area now has two with another soon to be built. All are associated with one of the enormous hospital systems we have here. All have complete radiologic suites, pharmacies, helipads, etc. I see absolutely nothing wrong with them as the monies all go into the same pot rather than a private, for profit facilities that indeed do siphon off the insured patients. In my previous job I frequently picked up patients from freestanding ER's and, frankly, the care they gave was on par with regular EDs. If they take the pressure off of over-burdened hospital based EDs then I think it's great idea.

[Not_A_Hat_Person, RN]

My state has had problems with hospital-affiliated free-standing ERs advertising as Walk-In Clinics, but charging like ERs. I went to one expecting to pay a $40 in-network co-pay, and was very surprised that they expected a $250 ER copay. Non-hospital Urgent Care centers in my state don't accept Medicare or Medicaid, but hospital-affiliated Urgent Care centers do.

[TheGooch]

These free standing ER are real ER's they have CT scanners and do anything a "real" emergency room does. They are licensed just like the ER is licensed that is attached to a hospital.

Free-Standing Emergency Rooms Causing Controversy

Critics say simple ERs create more demand and drive up costs

These are run by fully board certified emergency physician groups and not attached to any hospital in most cases....depending on state law. They will give TPA and transport. They take strokes and will transfer for admission.

Stand-alone emergency rooms are a popular, but very expensive ...

Freestanding emergency departments | The hospital s new front door

Freestanding Emergency Rooms Continue Growth Across North Texas

Emergency Care, But Not At A Hospital - Kaiser Health News

I live in the city that article focuses on. There are 2 hospital systems in the city with 2 hospitals each. I have been to all of the ERs and the wait can be hours because 2 of them are level 2 trauma centers-one of them being the busiest in the state. The other 2 are in more affluent areas and the wait there can be long too. As for the "ERs R US" I have never been to it.

And it was just announced last year that both level 2's are seeking level 1 designation so expect the wait time to increase since there are no level 1 in the southern part of the state were this is.

[ADeks]

So is this free standing ER in a different part of town? Is that why it's free standing?

It's actually only 20 minutes away from the main hospital.