Free-standing emergency centers

There is an increasing trend toward more and more Free-Standing Emergency Centers (FSECs), and this trend shows no signs of slowing down. But, what are they? It is important to learn the definitions, regulations and pros and cons of this relatively new modality of emergency care, as well as what this can mean for patients with emergencies that need attention.

To begin with, one may wonder how FSECs differ from Urgent Care Centers (UCCs). All emergency departments, free-standing and otherwise, are prepared to deal with the full array of emergencies, including trauma and critically ill patients. Urgent Care Centers treat only minor injuries and illnesses; any patient needing a more in-depth evaluation would be transferred to a full-fledged emergency department. An FSEC is equipped to deal with a much wider range of emergencies.

There are two types of FSECs. True FSECs are not associated with a hospital. They function and are owned independently, using the surrounding hospitals solely to admit patients. The other type, satellite FSECs, also called Hospital Outpatient Departments (HOPDs), are associated with a hospital or hospital system and are satellite centers that rely on and are part of the greater hospital system. These are also referred to as “off-site” hospital-based or satellite emergency departments. The two types are subject to different regulations and licensing rules. However, they all should be staffed with emergency physicians and have onsite radiology (including CT scans and ultrasounds), laboratory facilities for fast turn-around time, ambulance bay access, a trauma room and a transfer agreement with the closest local hospital. Specific state regulations differ at this time, but as the number of these centers increases, there is bound to be more uniform regulation.

In the meantime, the American College of Emergency Physicians (ACEP), the main professional organization for the specialty of emergency medicine, has published a policy statement on Freestanding Emergency Departments. In the absence of uniform guidelines, the ACEP recommends that, because they are facilities that present themselves as Emergency Departments, FSECs should be open 24 hours a day, seven days a week, 365 days a year, staffed by qualified emergency physicians, have adequate personnel to meet the anticipated needs, be staffed by a registered nurse with advance life support qualifications and have policy agreements in place for transfer to a higher level of care if needed.

If these guidelines are met, then there are many benefits to the communities in which these FSECs operate. For more rural areas, they may provide critical access to emergency care in places where building a full-fledged hospital may not be feasible due to population and budget restrictions, but where the needs exceed that which can be met with UCCs. They also tend to have faster turn-around times, regardless of location, and higher patient satisfaction scores than traditional hospital-based emergency departments.

The main downside of these centers is that they are not physically connected to a hospital, so a patient requiring additional care, such as admission or surgery, would have to be transported to the pre-determined receiving facility. With nationwide emergency department admission rates hovering around eight percent, according to the CDC’s National Center for Health Statistics, it seems doubtful that this would be a big downside for most patients.

In summary, for the average patient who has a medical condition that seems more serious than the minor cuts and colds that are treated in Urgent Care Centers, but who wants to avoid the potentially overwhelming chaos of a big hospital Emergency Department, an FSEC might be the right option.