The number of freestanding emergency departments in the United States has increased dramatically in the past decade, responding rapidly and efficiently to the increase in visits to emergency rooms. At nearly the same time, the number of hospital-based emergency rooms has dropped by 27% since 1990, according to a study published last spring in the Journal of the American Medical Association.1 Why are hospitals losing their emergency departments? Are freestanding emergency departments up to the task of replacing them? How can a community ensure that in-and-out healthcare is just what the doctor ordered?
Whither emergency departments?
In 1990, there were 2,446 hospitals with emergency departments in nonrural areas of the United States. That number had dropped to 1,779 by 2009. Researchers found that emergency departments were most likely to have closed if they were in hospitals with low profit margins, served large numbers of the poor and Medicaid patients, were at commercially operated hospitals, or operated in highly competitive markets.
While these emergency departments were closing, visits were soaring, increasing by 30% between 1998 and 2008. Overcrowded emergency departments contribute to longer waiting times, create unsatisfactory patient conditions, and escalate the cost of healthcare, making a crisis situation even more dire.
Many patients would avoid the emergency room altogether if primary care physicians were more immediately accessible. Indeed, the number of primary care health professionals nationwide continues to plummet. According to the Association of American Medical Colleges, the nation will have a shortage of approximately 21,000 primary care physicians in 2015, due to the needs of an aging population and a decline in the number of medical students choosing primary care.2
Freestanding emergency departments (FEDs), less expensive than a hospital to build and maintain, may just bridge the gap between what can be done in a traditional outpatient clinic and an acute care hospital, and can serve people, particularly in rural areas, where access to emergency care is limited.
According to the American Hospital Association, there were 241 FEDs in 2009, 65% more than there were just five years before, when there were 146 such facilities. Now located in 16 states, FEDs are capable of delivering excellent service, significantly upgrading the quality of healthcare available in their areas.
Where there are large distances between population centers and limited helicopter transportation, the FED may be the only facility that can provide any significant emergency care. They are generally open 24/7 and are staffed by emergency physicians and nurses. The AHA reports that some FEDs clock a door-to-doctor time of 30 minutes or less, compared with hospital emergency department door-to-doctor times of 55.8 minutes, on average. In addition, FEDs report an average door-to-discharge time of 90 minutes or less, compared with the hospital-based emergency room average time of 180 minutes.
FED caregivers can stabilize patients and provide initial treatment to those with a wide range of emergent problems. They often have arrangements with local emergency medical services personnel to deliver patients elsewhere who need services not available at the facility. It is a positive trend and an effective way to meet increased emergency needs without adding expensive hospital square footage.
Case study in New Jersey
The new AtlantiCare Satellite Health Center in Hammonton, New Jersey, is a classic case. When Kessler Memorial Hospital closed its doors in 2009, it left some Central Jersey residents 20 miles away from the closest hospital. To prevent a crisis in the underserved region, the State Department of Health asked AtlantiCare, which has several acute care facilities across the state, if it would establish and maintain an emergency department in Hammonton. The state got much more than it had requested.