More emergency rooms open away from hospitals

This commuter suburb near Washington, D.C., boasts new homes, shopping centers, plenty of traffic — and a state-of the-art 21-room emergency department tucked into an office complex.

Unlike most emergency departments, however, there are no patients awaiting transfer upstairs to a medical ward, because there is no medical ward.

The nearest hospital is about 8 miles away.

"A lot of people were skeptical" about the idea at first, says Robert Jepson, associate vice president of Adventist HealthCare, which owns both the nearby hospital and the free-standing emergency center.

High-tech emergency departments such as this one — staffed with doctors and nurses but often miles from a hospital — are increasing rapidly nationwide. The centers offer convenience to patients and can ease overcrowding in nearby hospital ERs. Yet, they also have spurred questions about their limited services, their ability to decrease the overall burden for area hospitals and their impact on health care spending.

The number of such facilities owned by hospitals or entrepreneurial doctors grew 23% from 2005 to 2006, jumping from 146 to 179, according to an American Hospital Association survey. About a dozen more are opening or in the planning stages in states such as Florida, Minnesota and Texas.

In September, a group of Houston doctors opened one in a shopping center next to a popular Mexican restaurant. It boasts posh waiting areas, wireless access and free coffee.

Another, owned by Mount Sinai Medical Center in Aventura, Fla., opened in January about a mile from rival Aventura Hospital and Medical Center.

The growth of stand-alone emergency departments comes amid continued overcrowding in hospital ERs and stiff competition among hospitals to expand their business in fast-growing suburbs.

The free-standing centers, open around the clock, often offer shorter wait times than hospital-based departments and can treat a variety of illnesses and problems, such as fevers, broken bones and serious cuts.

Yet, some experts, such as health care consultant Jim Unland, say that stand-alone ERs also can siphon patients with minor ailments away from lower-cost urgent care centers or doctors' offices, increasing costs to insurers and consumers. Urgent care centers differ from free-standing ERs because they usually are not open 24 hours and don't have the same level of high-tech equipment.

Ambulances generally won't bring the most critically ill to the stand-alone centers, including trauma patients and those having strokes or heart attacks. In Miami, ambulances won't bring patients to stand-alone ERs at all.

Patients who arrive on their own — the majority at most ERs — and need surgery or cardiac procedures must be rushed by ambulance to hospitals, a potential delay in treatment that worries some emergency service providers.

"We only transport to hospitals," says Elizabeth Calzadilla-Fiallo, spokeswoman for the Miami-Dade County Fire Rescue Department, which refuses to take patients to a newly opened center there. "If we transport to a stand-alone, and the patient actually needs more than the stand-alone can provide, you're compromising care."

Jepson and others say the centers provide the same high-level care given at hospital-based ERs and can handle just about any emergency, rapidly stabilizing patients, then sending them to a hospital for further treatment.

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