Free-standing ER

Trauma Columnist · Jul 17, 2006

Wow - unsure what a free-standing ER is! Would seem to be risky because most guidelines for many types of patients require further intervention like cardiac cath lab, CT, ultrasound exams, extensive x-rays, immediate surgery. How far away is your hospital.

The ratio of 1:6 is higher than the ENA recommends at 1:4. I would wonder about the acuity too because if you are far from a hospital, where is your back-up if you get multiple high acuity patients.

I would ask for a shadowing experience.

UMichSCN07 · Jul 24, 2006

As a prehospital health provider, I have a facility in my service area that is licensed as a free-standing ER and I transfer people out to the parent hospital (45-60 minutes away non-emergent) and other local hospitals all the time. The upside is that the staff never has to take care of really high acuity patients for very long; stabilize, then transfer, plus there aren't all that many higher acuity patients that come to the facility anyway (although, there is a transporting fire dept. that takes patients there quite frequently). The downsides, as I see them, is the knowledge that for those higher acuity patients, there is a considerable delay in definitive care, and the fact that anyone needing further diagnostics has to be shipped out, even if it's as straight-forwards as a broken bone or dislocation. Other than that, the free-standing ER is just a 24-hour urgent care with X-ray and (sometimes) CT capabilities.

Mike in Michigan

RunnerRN, BSN, RN · Jul 26, 2006

Sounds scary to me. Does EMS still have to take coding pts to this facility if it is the closest? Those patients are never straightforward.....i.e. the patient who drops into VF/VT because of an aortic dissection. Maybe my first thought is "RUN" because I've never heard of anything like this, but it just seems like too much liability to me - esp with the 6:1 ratio. Trauma's suggestion to shadow sounds like a smart one.

debbyed · Jul 27, 2006

:confused: If this is like a patient first center or Urgent care center with mainly non-urgent patients 6-1 is about the norm around here. If this is however a true ER anything above 1-4 can be a serious liability. Does this place actually have a triage system or are the patients taken on a first come, first serve basis?

If this is a true ER, with medics bringing in patients I would suggest you look elseware where you would have more resources.

SnowymtnRN · Jul 28, 2006

THere's a new one here in Denver and so far the patients and the staff LOVE it. But i'm not sure how it all works just yet. Its a Healthone system here.

JaredCNA, CNA · Dec 17, 2007

Even scarier, there is a new one opening here in 2009.

It's not just a free-standing ER though, there is also a women and children's center (L&D, Recovery). So if the newborn baby goes downhill, there is no NICU. If the birthing mother goes downhill, there is no MICU. As far as I know there is no OR, which would be bad if any emergency C-Section is needed.