The case for freestanding ERs
In recent years, visits to U.S. hospital emergency departments hit record highs, reaching 114 million visits in 2003 according to data from the Centers for Disease Control and Prevention. At the same time, the number of hospitals with emergency departments has continually decreased. Many hospitals can’t afford the cost of building an entire hospital to provide emergency care to smaller communities despite the increased need.
The trend of growing ER visits and decreasing numbers of hospitals has led to overcrowded ERs and caused excessive wait times, leaving many people in rural areas lacking quick access to medical care. To remedy this growing problem, some communities and hospitals are turning to stand-alone, or freestanding, ERs.
Freestanding ERs can benefit patients by keeping medical care within reach, while also giving hospital administrators an affordable alternative for offering ER services without the expense of constructing an entire hospital. Some experts believe that if current standalone ERs continue to prove successful, the country will likely be seeing many more of them in the near future.
Freestanding ERs ultimately supply the same services and equipment as in-hospital ERs, while offering the financial advantage to hospitals of being a cost-effective way to expand their reach. While they’ve been around for more than 40 years, stand-alone ERs are becoming more popular as communities see a growing need for emergency care, often the primary medical resource for the uninsured. But the demand is often not enough to justify a full-service hospital. The attraction of standalone ERs for hospital administrators is the opportunity to introduce a presence in a new marketplace with the potential to expand into a full hospital in the future.
The Graham Group, an Iowa real estate firm specializing in developing and owning medical office buildings, was recently contracted to develop and own the Morton Plant Mease (MPM) Bardmoor Emergency Center in the Largo area of greater Tampa, Florida. TRO, a national healthcare architectural firm, provided architectural and engineering services for the project.
The freestanding ER provides the same services as it would if it were attached to a hospital. Two in-hospital ERs in the area closed in recent years, indicating that a full-service hospital couldn’t be justified.
MPM’s 15,000-square-foot, 15-bed facility opened in March 2008 and offers the same services provided in hospital ERs, including diagnostic imaging, lab services, and a pharmacy. The ER is staffed by board-certified emergency physicians and specialty technicians. Care is provided 24 hours a day, seven days a week, and patients who need to be admitted for follow-up care can be transferred to the Morton Plant parent hospital.
The Bardmoor ER is subject to the same regulatory and accreditation standards as hospital-based ERs set forth by Florida’s Agency for Health Care Administration (AHCA). AHCA standards require ERs to have their own entrance separate from attached medical buildings and an ambulance drop-off. The ER must have its own mechanical system independent from the rest of the building, and be physically segregated from the balance of the building. The Bardmoor ER is also built to current hurricane hardening standards.
The Graham Group became involved in the project after contracting to develop and own a 75,000-square-foot medical office building for MPM. Several building occupants are specialties that now provide coverage to the new ER. The stand-alone ER was built after a statewide moratorium on freestanding ERs ended, and the hospital decided a free-standing ER would serve the medical needs of the community while being a cost-effective plan for MPM to extend services. Plans for the ER were quickly added to the first floor of the Bardmoor Medical Office Building, and it was constructed within a very limited time period.
The biggest challenges in the design and construction process were the intense schedule requirements. In a joint effort to get the project done in record time, a team of architects, engineers, the contractor, developer, and hospital representatives worked together from the conceptual design phase all the way through project completion. This led to two years of work being completed in 10 months—half the time normally required for design and construction.
The expeditious project was also aided by the fact that the standard type of building shell that the Graham Group designed and built allowed for an institutional occupancy required for an ER. In essence, the company didn’t have to redesign the existing shell to accommodate ER occupancy requirements.
In its initial operations, the Bardmoor Emergency Center has exceeded the volume expectations budgeted by Morton Plant Hospital. The ER is projecting to see 20,000 patients in the next year, roughly equal to what typical area hospital ERs would see.
It’s reasonable to believe stand-alone ERs will become more popular as hospitals realize they can increase outreach without investing in costly hospital constructions. Freestanding ERs extend the usefulness of the physical plant of the full-service hospital by extending its sphere of influence another 15 miles. That way, the hospitals that do exist get utilized more efficiently.
George Milligan is president of The Graham Group, Inc., a full-service real estate firm specializing in developing and managing medical office buildings. Located in Des Moines, Iowa, The Graham Group, Inc., has developed more than four million square feet of medical office space for a variety of healthcare clients across the nation.