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Freestanding emergency department

Catherine Gutierrez, Rachel A Lindor, Olesya Baker, David Cutler, Jeremiah D Schuur
Freestanding emergency departments (EDs), which offer emergency medical care at sites separate from hospitals, are a rapidly growing alternative to traditional hospital-based EDs. We evaluated state regulations of freestanding EDs and describe their effect on the EDs' location, staffing, and services. As of December 2015, thirty-two states collectively had 400 freestanding EDs. Twenty-one states had regulations that allowed freestanding EDs, and twenty-nine states did not have regulations that applied specifically to such EDs (one state had hospital regulations that precluded them)...
October 1, 2016: Health Affairs
George Molina, Bridget A Neville, Stuart R Lipsitz, Lorri Gibbons, Ashley Kay Childers, Atul A Gawande, William R Berry, Alex B Haynes
BACKGROUND: Surgical procedures in the United States are increasingly performed in the ambulatory setting, including freestanding ambulatory surgery centers (ASCs). However, there is a lack of research and tracking of surgical outcomes in this setting. MATERIALS AND METHODS: We analyzed data from a state all-payer claims database to produce a retrospective cohort study on the rate of acute care use (emergency department [ED] visits and inpatient admissions) within 7 d after operations performed in freestanding ASCs in South Carolina...
October 2016: Journal of Surgical Research
Robert L Kerner, Kathleen Gallo, Michael Cassara, John DʼAngelo, Anthony Egan, John Galbraith Simmons
Simulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together...
October 2016: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
Erin L Simon, Gregory Griffin, Kseniya Orlik, Zhenyu Jia, Dave Hayslip, Daniel Kobe, Nicholas Jouriles
BACKGROUND: It has been speculated that freestanding emergency departments (FEDs) draw more affluent, better-insured patients away from urban hospital EDs. It is believed that this leaves urban hospital-based EDs less financially secure. OBJECTIVE: We examined whether the distribution of patients with four types of insurance (self-pay, Medicaid, Medicare, and private) at the main ED changed after opening three affiliated FEDs, and whether the insurance type distribution was different between main ED and FEDs and between individual FEDs...
October 2016: Journal of Emergency Medicine
Jeremiah D Schuur, Olesya Baker, Jaclyn Freshman, Michael Wilson, David M Culter
STUDY OBJECTIVE: We determine the number and location of freestanding emergency departments (EDs) across the United States and determine the population characteristics of areas where freestanding EDs are located. METHODS: We conducted a systematic inventory of US freestanding EDs. For the 3 states with the highest number of freestanding EDs, we linked demographic, insurance, and health services data, using the 5-digit ZIP code corresponding to the freestanding ED's location...
July 1, 2016: Annals of Emergency Medicine
Daniel L Lodwick, Jennifer N Cooper, Peter C Minneci, Katherine J Deans, Daryl McLeod
BACKGROUND: Testicular torsion is a surgical emergency, and interhospital transfer could delay care and increase the risk of orchiectomy. This study identifies factors associated with transfer for pediatric testicular torsion. METHODS: This retrospective cross-sectional study examined emergency department (ED) visits for testicular torsion by men aged 1-21 y in National Emergency Department Sample from 2006 to 2012. Freestanding children's hospitals were excluded...
June 1, 2016: Journal of Surgical Research
Amy J Sloane, David M Pressel
BACKGROUND: Blood cultures and complete blood cell counts (CBCs) are commonly used in evaluating patients with skin and soft tissue infections (SSTIs). Published data have shown that these tests may not aid in patient management. The objective of this study was to decrease the collection of blood test specimens in children with uncomplicated SSTIs. METHODS: We designed a longitudinal preintervention/postintervention study that used modifications of well-known propaganda posters...
July 2016: Hospital Pediatrics
Nitish Patidar, Robert Weech-Maldonado, Stephen J O'Connor, Bisakha Sen, J M Mickey Trimm, Carlos A Camargo
BACKGROUND: Freestanding emergency departments (FSEDs) are fast growing entities in health care, delivering emergency care outside of hospitals. Hospitals may benefit in several ways by opening FSEDs. PURPOSE: The study used the resource dependence theory as a means to analyze the relationship between market and organizational factors and the likelihood of hospitals to operate FSEDs. METHODOLOGY: All acute care hospitals in 14 states with FSEDs present during the study period from 2002 to 2011...
June 15, 2016: Health Care Management Review
Silas W Smith, Catherine T Jamin, Sidrah Malik, Liliya Abrukin, Keegan M Tupchong, Ian Portelli, Glenn Asaeda, David J Prezant, Binhuan Wang, Ming Hu, Lewis R Goldfrank, Chad M Meyers
OBJECTIVE: To assess the impact of an emergency intensive care unit (EICU) established concomitantly with a freestanding emergency department (ED) during the aftermath of Hurricane Sandy. METHODS: We retrospectively reviewed records of all patients in Bellevue's EICU from freestanding ED opening (December 10, 2012) until hospital inpatient reopening (February 7, 2013). Temporal and clinical data, and disposition upon EICU arrival, and ultimate disposition were evaluated...
June 2016: Disaster Medicine and Public Health Preparedness
Kanu S Goyal, Sameer Jain, Glenn A Buterbaugh, Joseph E Imbriglia
BACKGROUND: More procedures are being completed on an outpatient basis at freestanding ambulatory surgery centers. The purpose of our study was to determine the safety and rate of adverse events in outpatient hand and upper-extremity surgical procedures. METHODS: A retrospective review of cases at a single, freestanding ambulatory surgery center over an eleven-year period was performed. In our analysis, 28,737 cases were performed and were included. Adverse events were defined as serious complications causing harm to a patient or leading to additional treatment...
April 20, 2016: Journal of Bone and Joint Surgery. American Volume
Adam B Goldin, Kurt F Heiss, Matt Hall, David H Rothstein, Peter C Minneci, Martin L Blakely, Marybeth Browne, Mehul V Raval, Samir S Shah, Shawn J Rangel, Charles L Snyder, Charles D Vinocur, Loren Berman, Jennifer N Cooper, Marjorie J Arca
OBJECTIVES: To define the incidence of 30-day postdischarge emergency department (ED) visits and hospital readmissions following pediatric gastrostomy tube (GT) placement across all procedural services (Surgery, Interventional-Radiology, Gastroenterology) in 38 freestanding Children's Hospitals. STUDY DESIGN: This retrospective cohort study evaluated patients <18 years of age discharged between 2010 and 2012 after GT placement. Factors significantly associated with ED revisits and hospital readmissions within 30 days of hospital discharge were identified using multivariable logistic regression...
July 2016: Journal of Pediatrics
Morgan K Richards, David Yanez, Adam B Goldin, Tim Grieb, Whitney M Murphy, George T Drugas
BACKGROUND: Unplanned readmissions are costly to family satisfaction and negatively associated with quality of care. We hypothesized that patient, operative, and hospital factors would be associated with pediatric readmission. METHODS: All patients with an inpatient operation from 10/1/2008 to 7/28/2014 at a freestanding children's hospital were included. A retrospective cohort study using multivariable forward stepwise logistic regression determined factors associated with unplanned readmission within 30 days of discharge...
September 2016: American Journal of Surgery
Benjamin J Lawner, Jon Mark Hirshon, Angela C Comer, Jose V Nable, Jeffrey Kelly, Richard L Alcorta, Laura Pimentel, Christina L Tupe, Mary Alice Vanhoy, Brian J Browne
OBJECTIVE: The objective of the study is to examine the effect of the opening of a freestanding emergency department (FED) on the surrounding emergency medical services (EMS) system through an examination of EMS system metrics such as ambulance call volume, ambulance response times, and turnaround times. METHODS: This study is based on data from the county's computer-aided dispatch center, the FED, and the Maryland Health Services Cost Review Commission. The analysis involved a pre/post design, with a 6-month washout period...
August 2016: American Journal of Emergency Medicine
Stephen J Fenton, Justin H Lee, Austin M Stevens, Kyle C Kimbal, Chong Zhang, Angela P Presson, Ryan R Metzger, Eric R Scaife
BACKGROUND: Injured children are often treated at one facility then transferred to another that specializes in pediatric trauma care. The purpose of this study was to identify and characterize potentially preventable transfers (PT) to a freestanding level-I pediatric trauma center. METHODS: Children with traumatic injuries transferred between 2003 and 2013 were retrospectively analyzed. A PT was defined as a child who was discharged within 36hours of arrival without surgical intervention or advanced imaging studies...
April 2016: Journal of Pediatric Surgery
Gerald A Beathard
Dialysis vascular access planning, creation, and management is of critical importance to the dialysis patient population. It requires a multidisciplinary approach involving patients and their families, dialysis facility staff, the nephrologist, the surgeon, and the interventionalist. With the emergence of interventional nephrology as a subspecialty of nephrology, the nephrologist is increasingly providing both the nephrology and interventional aspects of care, and in some areas, the surgical functions as well...
September 2015: Kidney Research and Clinical Practice
James C Robinson, Timothy T Brown, Christopher Whaley, Kevin J Bozic
BACKGROUND: Hospital-based outpatient departments traditionally charge higher prices for ambulatory procedures, compared with freestanding surgery centers. Under emerging reference-based benefit designs, insurers establish a contribution limit that they will pay, requiring the patient to pay the difference between that contribution limit and the actual price charged by the facility. The purpose of this study was to evaluate the impact of reference-based benefits on consumer choices, facility prices, employer spending, and surgical outcomes for orthopaedic procedures performed at ambulatory surgery centers...
September 16, 2015: Journal of Bone and Joint Surgery. American Volume
Leticia A Shanley, Carla Hronek, Matthew Hall, Elizabeth R Alpern, Evan S Fieldston, Paul D Hain, Samir S Shah, Michelle L Macy
OBJECTIVE: Observation unit (OU) use has been promoted recently to decrease resource utilization and costs for select patients, but little is known about the operations of pediatric OUs. This study aimed to characterize the infrastructure and function of OUs within freestanding children's hospitals and to compare characteristics between hospitals with and without OUs. METHODS: All 43 freestanding children's hospitals that submit data to the Pediatric Health Information System were contacted in 2013 to identify OUs that admitted unscheduled patients from their emergency department (ED) in 2011...
September 2015: Academic Pediatrics
David H Wisner, Nathan Kuppermann, Arthur Cooper, Jay Menaker, Peter Ehrlich, Josh Kooistra, Prashant Mahajan, Lois Lee, Lawrence J Cook, Kenneth Yen, Kathy Lillis, James F Holmes
BACKGROUND: Management of children with intra-abdominal solid organ injuries has evolved markedly. We describe the current management of children with intra-abdominal solid organ injuries after blunt trauma in a large multicenter network. METHODS: We performed a planned secondary analysis of a prospective, multicenter observational study of children (<18 years) with blunt torso trauma. We included children with spleen, liver, or kidney injuries identified by computed tomography, laparotomy/laparoscopy, or autopsy...
August 2015: Journal of Trauma and Acute Care Surgery
Carrie Daymont, Christopher P Bonafide, Patrick W Brady
BACKGROUND AND OBJECTIVES: Heart rate (HR) is frequently used by clinicians in the hospital to assess a patient's severity of illness and make treatment decisions. We sought to develop percentiles that characterize the relationship of expected HR by age and body temperature in hospitalized children and to compare these percentiles with published references in both primary care and emergency department (ED) settings. METHODS: Vital sign data were extracted from electronic health records of inpatients <18 years of age at 2 large freestanding children's hospitals from July 2011 to June 2012...
May 2015: Pediatrics
Adam B Schlichting, Jayna M Gardner-Gray, Gina Hurst
BACKGROUND: With improvements in endoscopic and interventional radiologic therapies, insertion of gastroesophageal balloon tamponade catheters, commonly known as Sengstaken-Blakemore or Minnesota tubes, is a rarely performed procedure for esophageal or gastric variceal bleeding. In small hospitals or freestanding emergency departments, endoscopic or interventional radiology (IR) therapies might not be available, so patients with exsanguinating variceal bleeding must be stabilized or temporized for transport to larger hospitals...
July 2015: Journal of Emergency Medicine
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