The following is a summary of “Patients utilizing emergency medical services – Does facility type matter?,” published in the June 2023 issue of Emergency Medicine by Simon, et al.
Emergency departments (EDs) play a crucial role in the US healthcare system, and the integration of freestanding EDs (FSEDs) has become more common. As local EMS providers transport patients to FSEDs, which may offer faster turnaround times and are closer in proximity, researchers sought to investigate if patients transported via EMS to FSEDs require fewer tests and have lower admission rates compared to those transported to hospital-based EDs (HBEDs).
They conducted a retrospective cohort study of all patients who presented via EMS to one of 10 HBEDs or 6 FSEDs within a large integrated hospital system between April 1, 2020, and May 1, 2021. Categorical variables were presented as frequencies and percentages, and group comparisons were assessed using chi-squared tests. Continuous variables were presented as mean and standard deviation, and p-values for group comparisons were obtained using t-tests. Multiple logistic regression was used to assess the effect of ED type on admission status, labs ordered, and testing performed, controlling for various factors.
The study included a total of 123,120 encounters. The mean age at the FSEDs was 59.9 years, with a median age of 61.3 years at the HBEDs. Female patients accounted for 55.6% (n=4,675) at the FSEDs and 53.0% (n=60,809) at the HBEDs. Additionally, 82.0% (n=6,805) of patients at the FSEDs were White, compared to 60.7% (n=68,430) at the HBEDs. The proportion of patients with Medicare was similar between the two settings, with 50.0% (n=3974) at the FSEDs and 50.9% (n=55,372) at the HBEDs.
Significant differences were observed between the two groups regarding testing frequency and admission rates. At the FSEDs, 69.5% (n=5,846) of patients had bloodwork, whereas 82.4% (n=94,512) had it at the HBEDs. X-rays were performed on 68.3% (n=5,745) of patients at the FSEDs, and 70.7% (n=81,089) had them at the HBEDs. The study also found that 40.1% (n=3,370) of patients had a CT scan at the FSEDs, compared to 44.9% (n=51,503) at the HBEDs. Furthermore, the admission rate at the FSEDs was 40.6% (n=3,412), notably lower than the 56.1% (n=64,355) admission rate at the HBEDs. In the logistic regression model, after adjusting for the Charlson Comorbidity Index, acuity, age, gender, sex, insurance, and race, patients transported via EMS to FSEDs were found to be 35% less likely to be admitted compared to those transported to HBEDs.
Patients brought in via EMS to FSEDs showed lower rates of blood work, x-rays, and CT scans, and they were less likely to be admitted to the hospital than those transported to HBEDs. The findings had implications for resource utilization and patient outcomes and may indicate potential differences in care delivery between the two types of emergency departments.