The impact of a freestanding ED on a regional emergency medical services system

Lawner, Benjamin J.; Hirshon, Jon Mark; Comer, Angela C.; Nable, Jose V.; Kelly, Jeffrey S.; Alcorta, Richard L.; Pimentel, Laura; Tupe, Christina L.; Vanhoy, Mary Alice; Browne, Brian J.

doi:10.1016/j.ajem.2015.11.042

Cited by 14 publications

(15 citation statements)

References 9 publications

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“…Past research has observed that ambulances preferentially route higher-acuity patients with diseases or injuries that will be more costly to hospitals instead of freestanding EDs. 26 Moreover, it is difficult to claim that hospital-based EDs have a cost advantage over freestanding EDs owing to economies of scale because past research has concluded that the average cost per visit does not decline as the number of patients treated increases in EDs. 27 Future studies should be conducted examining detailed cost data by facility type to determine in which instances the relatively equivalent prices between freestanding and hospital-based EDs for specific diagnoses and procedures may be justified.…”

Section: Discussionmentioning

confidence: 99%

Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers

Metcalfe

Dark

et al. 2017

Annals of Emergency Medicine

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Results: Texans use hospital-based EDs and urgent care centers much more than freestanding EDs, but freestanding ED utilization increased 236% between 2012 and 2015. The average price per visit was lower for freestanding EDs versus hospital-based EDs in 2012 ($1,431 versus $1,842), but prices in 2015 were comparable ($2,199 versus $2,259). Prices for urgent care centers were only $164 and $168 in 2012 and 2015. Out-of-pocket liability for consumers for all these facilities increased slightly from 2012 to 2015. There was 75% overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60% overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers. Conclusion:Utilization of freestanding EDs is rapidly expanding in Texas. Higher prices at freestanding and hospitalbased EDs relative to urgent care centers, despite substantial overlap in services delivered, imply potential inefficient use of emergency facilities.

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Section: Discussionmentioning

confidence: 99%

Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers

Metcalfe

Dark

et al. 2017

Annals of Emergency Medicine

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“…According to the WHO, an ideal response time is equivalent to less than 8 minutes 5 . Regarding the definition of response time, Lawner et al 7 consider secondary outcomes, which include changes in other main ambulance time metrics such as average ambulance response interval (time from ambulance dispatch to arrival at the scene) and overall out-of-service interval (the amount of time that an ambulance is not available to respond to another incident). Vile et al 8 further stresses that response times are one of WEST's Key Performance Indicators (KPIs) since they are believed to provide a good indication of the quality and timeliness of care provided by the service.…”

Section: IIImentioning

confidence: 99%

Response time in the emergency services. Systematic review

et al. 2018

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The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.

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“…The same study, however, found that overall visits to the system (the hospital-based ED and the freestanding EDs combined) increased by 45%. Lawner et al 43 also found that after the opening of a freestanding ED, overall visits to it and nearby hospital-based EDs increased 15.8%. Dark et al 28 found no significant association between hospitalbased ED wait times and the presence of nearby freestanding EDs, calling into question whether freestanding EDs actually alleviate crowding.…”

Section: Effects On Hospital-based Emergency Departmentsmentioning

confidence: 97%

“…A freestanding ED in Maryland was found to be associated with decreased calls, shorter advanced life support unit turnaround times, and shorter ambulance out-of-service intervals by providing more readily available access to care in a rural area of the state. 43 EMS may also need to determine whether transport to a freestanding ED is an appropriate decision or whether a patient is likely to need additional hospital resources and should be transported to a hospital-based ED instead. In a study of 2 county EMS agencies in Florida, Hwang et al 45 found that approximately 75% of patients transported to freestanding EDs did not require additional hospital resources, with 70% being discharged home.…”

Section: Effects On Hospital-based Emergency Departmentsmentioning

confidence: 99%

Freestanding Emergency Departments: What Is Their Role in Emergency Care?

Alexander

Dark

2019

Annals of Emergency Medicine

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Freestanding emergency departments (EDs), health care facilities that offer emergency care without being physically attached to a hospital, are becoming more common throughout the United States. Many individuals propose that these facilities can help alleviate the stress our current emergency care system faces and provide care to people with limited access to traditional hospital-based EDs. We reviewed the current literature on freestanding EDs to investigate whether these facilities are meeting those goals. We found that although they provide care that is generally similar in quality and cost to that of hospital-based EDs, freestanding EDs tend to cater to a more affluent patient population that already has access to health care instead of expanding care to underserved areas. This, coupled with a fragmented system of state-by-state regulation, leads us to recommend implementing more uniform licensing criteria from state to state, encouraging freestanding EDs to operate in more rural and underserved areas, and increasing price transparency.

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The impact of a freestanding ED on a regional emergency medical services system

Cited by 14 publications

References 9 publications

Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers

Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers

Response time in the emergency services. Systematic review

Freestanding Emergency Departments: What Is Their Role in Emergency Care?

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