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Free Standing Emergency Departments - FSEDS

There is a boom in the development of Free Standing Emergency Departments in America and they are being hailed by medics and patients alike as the way forward in the provision of emergency care, especially in rural areas. The first one was established in 1970 but it is only in the past decade that the provision of such a facility was recognised as a safe, efficient and patient-friendly method of treating emergencies. Many of the FSEDs have been set up as Private businesses and more and more are coming on stream, which obviously indicates that the public want to use these facilities.

There were and still are groups who are against them and have tried to stop this development but the majority are very favourable towards them. Many of the FSEDs have been set up by hospital groups to provide safe services for the people in their catchment area, who are isolated. However many have also been set up in towns and cities in shopping centres and not as part of the local hospital building. These are meant to relieve the pressure on the Hospital A & E and allow safer and more timely services in the A & E for major trauma. Those who are objecting to the FSEDs usually have a vested interest of their own to defend and want the health services to continue doing what they have always done in the way they have always done it even though patients were not at the forefront of the decision making.  The charges set by the FSEDs for services is the main bone of contention and the possibility that they will take ‘trade’ away from Primary Care is also causing objections to them. Many states make it almost impossible for FSEDs to get a licence in order to prevent service redundancy and ensure that other local care providers will not suffer financially from competition. Again finance is being put before patient needs. Some places independent FSEDs are not covered by health Insurance companies because they are not under federal regulations. However FSEDs boast little or no wait times, convenient locations, and very high patient-satisfaction scores. Studies show that FSEDs can achieve hospital-level quality of care, even for the most serious, time-critical conditions, such as heart attack and stroke.

Like a hospital-based Emergency Department, an FSED provides, at minimum, 24/7 access to an emergency physician, an emergency nurse, laboratory and radiology technicians, moderate-complexity blood testing and advanced imaging such as computed tomography and ultrasound (in addition to X-ray). And FSEDs can care for most emergent illnesses, including heart attack, stroke, and minor trauma. Most FSEDs transfer patients to a full-service hospital for any emergent subspecialty need, an operation, or hospitalisation but some have in-patient facility for observation purposes.  Patients are encouraged to visit the FSED first and, if required, they will be transferred to a hospital whose expertise matches their specific needs, such as stroke care, cancer care, or simply observation. The result: They get services where and when they need them. At least 10% of hospital admissions are for patients with conditions, such as pneumonia, that require care and observation but don’t require a hospital admission with its full array of services, such as in-house specialists or operating rooms. All of the FSEDs are equipped with telemedicine services to offer consultations with hospital-based specialty physicians, without the time and costs of transportation to the hospital. 90% of patients who attend FSEDs do not require in-hospital treatment or observation and can be discharged home. Some FSEDs have now developed a Homecare, where a nurse can call to a patient who has attended the FSED to check on their condition at home.

‘As the U.S. strives for more-efficient, lower-cost, higher-quality health care, we need innovators that are willing to experiment with new payment models, delivery systems, and care processes. Hospitals, with their thousands of employees, entrenched cultures, and high fixed costs, might be the least nimble players in all of health care. Let’s not close the door on an innovative, potentially disruptive model like freestanding EDs. Instead, let’s recognise what they do well — timely, high-quality care, close to home — and figure out how they can complement, rather than compete with, the overall care-delivery system’ – this is a quotation from  Nir Harish, MD, MBA; Jennifer L. Wiler, MD, MBA; and Richard Zane, MD; who are  from Yale Department of Emergency Medicine;  University of Colorado School of Medicine; and CU Business School, CU Health System; respectively. Perhaps the same could be applied to Ireland.