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Freestanding emergency center

Gregg R Klein, Jason M Posner, Harlan B Levine, Mark A Hartzband
BACKGROUND: There is an increasing interest in outpatient total hip arthroplasty (THA), as there are perceived benefits to the patient, insurer, and overall healthcare system. However, the safety of outpatient total joint arthroplasty has not been studied. METHODS: Five hundred forty-nine patients who underwent mini-posterior THA at a freestanding independent ambulatory surgical center (ASC) were reviewed. All patients were discharged to home on the day of surgery...
October 20, 2016: Journal of Arthroplasty
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
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
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
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
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
Maribel Cifuentes, Melinda Davis, Doug Fernald, Rose Gunn, Perry Dickinson, Deborah J Cohen
PURPOSE: This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. METHODS: This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care...
September 2015: Journal of the American Board of Family Medicine: JABFM
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
Erin L Simon, Mitch Kovacs, Zhenyu Jia, Dave Hayslip, Kseniya Orlik, Nicholas Jouriles
INTRODUCTION: Freestanding emergency departments (FEDs) have grown in popularity. They often provide emergent care in areas distant from other EDs. Investigations and research to characterize the operation and dynamics of FEDs are needed. This study characterizes the severity of illness seen at FEDs and compares it with a hospital-based urban tertiary care ED using the emergency severity index (ESI), a quantification of patient acuity. METHODS: Patient ESI levels were analyzed retrospectively over 1 year for a single hospital system with 1 main urban hospital-based ED and 3 FEDs...
April 2015: American Journal of Emergency Medicine
Erin L Simon, Kantha Medepalli, Carolyn J Williams, Andrew Yocum, Eric Abrams, Gregory Griffin, Kseniya Orlik
BACKGROUND: Freestanding emergency departments (FEDs) continue to grow in number and more research is needed on these facilities. OBJECTIVE: We sought to characterize the types of injuries and patients who initially presented to two FEDs and were transferred to the main tertiary care ED for trauma team consult and admission. METHODS: This retrospective cohort descriptive study examined medical records of adult trauma patients who were initially seen at an FED and then transferred to the main ED...
February 2015: Journal of Emergency Medicine
Jonathan D Gates, Sandra Arabian, Paul Biddinger, Joe Blansfield, Peter Burke, Sarita Chung, Jonathan Fischer, Franklin Friedman, Alice Gervasini, Eric Goralnick, Alok Gupta, Andreas Larentzakis, Maria McMahon, Juan Mella, Yvonne Michaud, David Mooney, Reuven Rabinovici, Darlene Sweet, Andrew Ulrich, George Velmahos, Cheryl Weber, Michael B Yaffe
OBJECTIVE: We discuss the strengths of the medical response to the Boston Marathon bombings that led to the excellent outcomes. Potential shortcomings were recognized, and lessons learned will provide a foundation for further improvements applicable to all institutions. BACKGROUND: Multiple casualty incidents from natural or man-made incidents remain a constant global threat. Adequate preparation and the appropriate alignment of resources with immediate needs remain the key to optimal outcomes...
December 2014: Annals of Surgery
Rita V Burke, Tae Y Kim, Shellby L Bachman, Ellen I Iverson, Bridget M Berg
INTRODUCTION: Children are particularly vulnerable during disasters and mass-casualty incidents. Coordinated multi-hospital training exercises may help health care facilities prepare for pediatric disaster victims. PROBLEM: The purpose of this study was to use mixed methods to assess the disaster response of three hospitals, focusing on pediatric disaster victims. METHODS: A full-functional disaster exercise involving a simulated 7.8-magnitude earthquake was conducted at three Los Angeles (California USA) hospitals, one of which is a freestanding designated Level I Pediatric Trauma Center...
December 2014: Prehospital and Disaster Medicine
Christopher P Bonafide, A Russell Localio, Lihai Song, Kathryn E Roberts, Vinay M Nadkarni, Margaret Priestley, Christine W Paine, Miriam Zander, Meaghan Lutts, Patrick W Brady, Ron Keren
OBJECTIVES: Medical emergency teams (METs) can reduce adverse events in hospitalized children. We aimed to model the financial costs and benefits of operating an MET and determine the annual reduction in critical deterioration (CD) events required to offset MET costs. METHODS: We performed a single-center cohort study between July 1, 2007 and March 31, 2012 to determine the cost of CD events (unplanned transfers to the ICU with mechanical ventilation or vasopressors in the 12 hours after transfer) as compared with transfers to the ICU without CD...
August 2014: Pediatrics
Elizabeth T Emrath, Jana A Stockwell, Courtney E McCracken, Harold K Simon, Pradip P Kamat
BACKGROUND: Freestanding imaging centers are popular options for health care systems to offer services accessible to local communities. The provision of deep sedation at these centers could allow for flexibility in scheduling imaging for pediatric patients. Our Children's Sedation Services group, comprised of pediatric critical care medicine and pediatric emergency medicine physicians, has supplied such a service for 5 years. However, limited description of such off-site services exists...
August 2014: Pediatric Radiology
Peter Ermis, Thomas Dietzman, Wayne Franklin, Jeffrey Kim, Douglas Moodie, Dhaval Parekh
OBJECTIVE: This article aims to give a comprehensive description of cardiac resource utilization in adults at a freestanding children's hospital. DESIGN: Retrospective chart review. SETTING: Large, tertiary, freestanding children's hospital. PATIENTS: Adults (18 years of age and older) seen within the heart center or evaluated by heart center personnel from January 1, 2006 through December 31, 2010. RESULTS: There were 2794 adults that utilized cardiology services during the study period...
May 2014: Congenital Heart Disease
David C Lee, Silas W Smith, Christopher M McStay, Ian Portelli, Lewis R Goldfrank, Gregg Husk, Nirav R Shah
A freestanding, 911-receiving emergency department was implemented at Bellevue Hospital Center during the recovery efforts after Hurricane Sandy to compensate for the increased volume experienced at nearby hospitals. Because inpatient services at several hospitals remained closed for months, emergency volume increased significantly. Thus, in collaboration with the New York State Department of Health and other partners, the Health and Hospitals Corporation and Bellevue Hospital Center opened a freestanding emergency department without on-site inpatient care...
April 9, 2014: Disaster Medicine and Public Health Preparedness
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