In King County, Wash., which includes Seattle, ambulances can take willing patients to stand-alone centers if the patients don't need paramedic care and don't seem to be having a heart attack, stroke, abdominal aneurysm or trauma.
Still, 85% of all emergency patients arriving at hospital emergency departments don't come by ambulance, Centers for Disease Control and Prevention statistics show. Some health experts wonder if those patients understand the difference between stand-alone centers and full-scale hospitals.
"There's been a lack of education to consumers," Unland says. "It would not surprise me … to see some regulation that when hospitals advertise (free-standing centers), they have to be specific about what they can and can't do."
Choked highways to hospital
In Maryland, hospital and state officials agreed the growing Germantown area needed its own ER, mainly to save residents from the drive down congested highways to the closest hospital, Shady Grove Adventist in Rockville, Md.
Maryland lawmakers approved the project as a pilot — and directed the state health department to create licensing standards for such stand-alone facilities. Ambulance crews are instructed not to bring patients to the free-standing center if it seems likely they will need to be hospitalized.
In its first year, the new center treated 22,010 patients. Of those, about 7% were taken to a hospital, mainly by ambulance. A helicopter was used in seven cases, mostly trauma patients or children needing specialized care at a children's hospital.
That year, the stand-alone emergency department helped reduce visits to Shady Grove's hospital ER by about 10,000, says Michael McAdams, an assistant chief with the Montgomery County Fire & Rescue Service.
Taking patients to the stand-alone center also saves travel time for the rescue crews based around Germantown, increasing their availability to handle other emergencies, he says.
Yet, some health care experts, including Maryland's Emergency Medical Services Systems Director Robert Bass, say that although stand-alone centers might help their communities, they won't solve overcrowding that plagues many urban emergency centers.
The stand-alone center didn't reduce the amount of time that Shady Grove diverted ambulances to other hospitals because it was overloaded. In fact, state records show the diversion time more than doubled in the year after the free-standing ER opened.
That's because two emergency departments — the hospital's and the free-standing facility — are now sending patients who need a hospital bed to Shady Grove, says Bass.
"If you're seeing more patients and admitting more patients … those patients are competing for beds," he says.
Still, he approves of stand-alone ERs — when patients use them properly.
"If you have chest pain or signs of a stroke, call 911," he says. "On the other hand … if you fall and think you may have a broken arm … or feel ill and don't know if you have the flu, it is perfectly appropriate to go to a (stand-alone) center like that."