March 20, 2018
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Emergency care, but not at a hospital

By Michelle Andrews, Special to The Washington Post

Emergency departments are struggling to keep up with demand. Since 1990, the number of hospital-based emergency departments has declined by 27 percent, according to a study published in the Journal of the American Medical Association in May. Meanwhile, the number of visits to hospital emergency departments has been on the rise, increasing 30 percent between 1998 and 2008.

One increasingly popular option to improve access to services is the free-standing emergency department, a facility that, as its name suggests, isn’t physically located within a hospital.

Services at these facilities get high marks, but questions remain about whether they’re the best choice for some serious medical problems. And some policy experts say the facilities may not be serving the people who need them most.

Free-standing emergency departments originally emerged to serve people in rural areas where access to emergency care was scarce. But in recent years, free-standing EDs have often been cropping up in fast-growing suburban areas where the need isn’t always as clear. Sometimes, experts say, it’s as an effort by health systems to muscle in on a competing hospital’s ED and siphon off some of its patients.

“It seems that now they’re being aimed at populations that do have a fair amount of access to health care already,” says Emily Carrier, a senior health researcher at the Center for Studying Health System Change, who is also an emergency physician.

Whatever the reason, they’re on the rise: In 2009, there were 241 free-standing emergency departments, compared with 146 four years ago, according to the American Hospital Association. They’re located in at least 16 states, according to a study for the California HealthCare Foundation.

One Saturday evening when Phil Dyer was puttering around the garden of his home in Issaquah, a Seattle suburb, he felt his heart begin to race, and his throat constricted so much that he could barely breathe. His wife drove him to a free-standing emergency department two miles away operated by Swedish Medical Center, a health-care system with four acute-care hospitals and three free-stan ding EDs.

Whisked directly into an exam room, Dyer was checked over by a doctor, who determined he was probably having an allergic reaction to a bug bite. He gave Dyer, 58, a shot of epinephrine and sent him home. The whole process took less than an hour. Before the Issaquah ED was built a few years ago, the nearest emergency department was at a hospital about 12 miles away. Having emergency care so close is “reassuring,” he says.

Unlike urgent care centers, which are limited in their hours and services, free-standing EDs are generally open 24/7 and are capable of handling more serious cases – for example, those that may require conscious sedation, intubation or defibrillation. Generally operated by larger health-care systems, they’re staffed by emergency physicians and nurses, and typically have lab and radiology  services on-site. They can stabilize and provide initial treatment to patients with a wide range of emergent problems.

They often have arrangements with local emergency medical services to immediately deliver patients elsewhere if necessary. “If they diagnose you as having a heart attack, they’re going to bypass our free-standing ER and go straight to the cath lab at the hospital,” says John Milne, a vice president at Swedish Health System.

If you’re facing a true emergency, don’t try to figure out what facility to drive to – let the pros sort out where you need to go. “If you’re having chest pain, you really ought to call 911,” says Sandra Schneider, president of the American College of Emergency Physicians.

Since free-standing EDs don’t have to handle as many acutely ill patients, it’s not surprising that their waiting times are generally shorter: door-to-discharge times may be 90 minutes or less, compared with 180 minutes for hospital EDs. Whether a shorter wait results in actual health benefits isn’t always clear, however.

“There’s some data showing that long wait times are a problem for some medical conditions,” says Carrier. “But it’s not necessarily clear that consumers will see improved health if they don’t have to drive an extra five minutes.”

This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.

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