Abstract
Objective
Compare clinical characteristics for adult visits to freestanding emergency departments
(FEDs) and a hospital-based ED (HBED).
Methods
Electronic health records were collected on adult ED visits from 7/1/14 to 6/30/15
from three FEDs and one level 1 trauma tertiary care HBED.
Results
There were 55,909 HBED visits; 44,108 FED visits. The FED population was slightly
more female (61% vs 57%), younger (48 vs 46 years), white (86% vs 60%), and employed
(67% vs 49%). A higher percent of FED visits had private insurance (43% vs 20%); a
lower percent had Medicaid (25% vs 42%) and Medicare (23% vs 30%). The top three presenting
problems were the same at the HBED and FEDs, but the order differed: gastrointestinal
(HBED 19% vs FED 18%), cardiorespiratory (18% vs 16%), injury-pain-swelling of extremity
(14% vs 17%). Differences were seen in primary ICD9 codes. One quarter of FED visits
and only 18% of HBED visits were for injury/poisoning. A higher percent of FED visits
were for respiratory diseases (12% vs 9%) but a lower percent were for circulatory
system diseases (7% vs 11%) and visits for mental illness (2% vs 6%). Nearly 30% of
HBED visits resulted in admission, compared to 8% of FED visits. ESI level differed
significantly, with a lower percent of high acuity cases at FEDs (level 1: 0.1% vs
1.6%; level 2: 5% vs 26%).
Conclusion
Differences were observed in clinical characteristics of adult HBED visits versus
FEDs. Results of this study can help communities plan their emergency care system.
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References
- Freestanding emergency departments.https://www.acep.org/Clinical---Practice-Management/Freestanding-Emergency-Departments/Date: June 2014Date accessed: March 22, 2017
- Freestanding emergency departments: do they have a role in California?.http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20F/PDF%20FreestandingEmergencyDepartmentsIB.pdfDate: July 2009Date accessed: March 22, 2017
- A profile of freestanding emergency departments in the United States, 2007.J Emerg Med. 2012; 43: 1175-1180https://doi.org/10.1016/j.jemermed.2012.02.078
- Where do freestanding emergency departments choose to locate? A national inventory and geographic analysis in three states.Ann Emerg Med. July 2016; https://doi.org/10.1016/j.annemergmed.2016.05.019
- Contextual factors associated with hospitals' decision to operate freestanding emergency departments.Health Care Manage Rev. June 2016; https://doi.org/10.1097/HMR.0000000000000113
- The impact of two freestanding emergency departments on a tertiary care center.J Emerg Med. 2012; 43: 1127-1131https://doi.org/10.1016/j.jemermed.2012.02.023
- A comparison of acuity levels between 3 freestanding and a tertiary care ED.Am J Emerg Med. 2015; 33: 539-541https://doi.org/10.1016/j.ajem.2015.01.021
- Patient Insurance Profiles: a tertiary care compared to three freestanding emergency departments.J Emerg Med. 2016; 51: 466-470https://doi.org/10.1016/j.jemermed.2016.05.058
- Annual estimates of the resident population: April 1, 2010 to July 1, 2015.https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtmlDate: 2016Date accessed: February 27, 2017
- Clinical Classifications Software (CCS) page.U.S. Agency for Healthcare Research and Qualityhttps://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jspDate accessed: June 5, 2017
Article Info
Publication History
Published online: July 02, 2018
Accepted:
June 30,
2018
Received in revised form:
June 28,
2018
Received:
February 17,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
