Freestanding Emergency Departments on the Rise

Although not the first stand-alone emergency department (ED) in the United States to open and probably not the last, Mount Sinai Medical Center’s facilty in Aventura, Florida, is the latest to follow this new paradigm in the healthcare industry that resembles those used for diagnostic imaging and ambulatory surgery centers (ASC).

According to Steven D. Sonenreich, CEO of Mount Sinai Medical Center, in an online interview with a WLRN-Miami Herald reporter, “we believe that this is the first of its kind here in south Florida.”

Currently, there are two other freestanding EDs in Florida and a third, located in Pinellas County, is set to open in March. A handful of new ones are also in the works now that Florida’s governor, Charlie Crist, overturned the ban to extend the 2003 moratorium on building these types of facilities.

With over 115 million visits to hospital EDs reported in 2005 by the National Hospital Ambulatory Medical Care (NHAMC) Survey, proponents of freestanding EDs say that they will increase access and efficiency, and decrease wait times and overcrowding, while still maintaining quality of care.

Whereas, opponents are concerned about possible reductions in the quality of care, siphoning patients from existing hospitals, and the hospital admission process, especially in an emergency surgical situation, if there is no adjacent hospital.

Regardless, healthcare facilities dedicated to non-acute emergencies are desperately needed to alleviate overcrowding in traditional hospital-based emergency departments and some states have already, or are considering, legislative and regulatory licensing allowances to permit freestanding EDs.

A study published in the January 15, 2008 online issue of Health Affairs found that the number of hospitals operating 24-hour EDs dropped 12 percent between 1997 and 2004 and the wait time to see an ED physician increased from 22 minutes in 1997 to 30 minutes, on average, in 2004, a 4.1 percent increase in wait time each year. Severely ill patients suffered the largest increases in ED wait times.

The increasing delays affected everyone, including those with and without health insurance and people from all racial and ethnic groups (African-Americans, Hispanics and women had to wait longer for care than whites and men, respectively). The average time spent in an emergency department in 2005 was 3.3 hours, according to the NHAMC survey.

The research, using data from the National Center for Health Statistics (NCHS), is the first detailed analysis of national trends in ED waits. The NCHS has found that ED crowding now causes one ambulance to be diverted away from a US emergency department every minute.

Lead author of the study, Andrew Wilper, M.D., an internist with Cambridge Health Alliance and a fellow in internal medicine at Harvard Medical School believes that the “increasing wait times are the result of a ‘perfect storm’ that has occurred as emergency department visits are on the rise while many EDs are closing their doors.”

Consequently, many view freestanding EDs as a prime business venture to meet the growing need in communities for emergency care, especially as more and more people seek their care through an emergency department rather than a primary care facility.

“It’s all about individuals wanting to access care and have their care expedited,” said Sonenreich in the online interview. “That’s where we see a very significant opportunity.”

Sonenreich added that the goal of their 5 million dollar investment is “to shorten these waiting times and get people to the appropriate level of care as quickly as possible. We believe our turnaround times will be quicker than you might experience at any neighboring emergency departments and that truly becomes the key to patients’ satisfaction with their care. They want to come in, be treated and leave as quickly as possible.”

The 11,000 square-foot freestanding ED in Aventura is housed in Mount Sinai's 65,000 square-foot building along with existing physician offices and an imaging center. It has 16 different exam bays, advanced diagnostic imaging with an on-site radiology technician, a full-service laboratory staffed 24/7, and shares a 64-slice CT scanner with the imaging center.

“This facility is very extensive in its technology and ability to provide service,” said Sonenreich during the Miami Herald interview.

At the stand-alone ED, an ambulance is available round the clock to transport patients to the nearby Aventura Hospital or Mount Sinai main campus, located 12 miles away, should they require inpatient hospitalization. “We anticipate seeing about 7,000 patients in the freestanding Aventura facility in the first year,” said Sonenreich.

Since the NHAMC survey reports that 12 percent of visits to an ED resulted in hospital admission and only one percent off visits required a transfer to a higher level of care or needed specialized care, then approximately 840 patients might need to be admitted.

Sonenreich believes that “what we are doing in Aventura is actually cutting-edge. Thirty years ago, it was the beginning of freestanding ASCs, separating the ambulatory surgery patient from the inpatient who required surgery. It was a different concept back then; there was a lot of push back and a lot of concern, because most people are uncomfortable with change. What we are seeing is something along those lines, where it’s something different, something new.”

“We believe that it is going to play a very significant role in terms of access and expediting care and so it may be different right now, but I would anticipate in the future that it will be something that will be much more commonplace.”