1. Assessing the Patient Experience of Care at Freestanding Emergency Departments
May 11, 2016
Erin Simon DO
Emergency Medicine Research Director Cleveland Clinic Akron General
Co-authors: John Dayton MD (PI), and Cedric Dark MD

2. No financial COI to disclose
Erin Simon DO, FACEP
No financial COI to disclose 2

3. Background
Freestanding emergency departments (FEDs) are expanding rapidly in the United States
In 2015, there were 387 FEDs hospital affiliated FEDs and 172 independent FEDs
FEDs currently represent 8-10% of all EDs across the United States

4. Background
The first goal of the Institute for Healthcare Improvement (IHI) Triple Aim Initiative is to “improve the patient experience of care (including quality and satisfaction)”

5. Objectives
We evaluated the performance of academic FEDs related to the IHI triple aim goal to “improve the patient experience of care”

6. Study design and setting
Retrospective chart review involving patients seen at 8 academic FEDs representing 4 academic centers

7. Selection of Participants
Data collected by Cleveland Clinic, Baylor, and the University of Utah represents patients seen at their respective FEDs in 2013 and 2014
Northwell Health data represents patients seen in their FED in 2014 (the year it opened)

8. Data Collection EHRs were used to evaluate the following data:
Number of patient visits
Number of ESI level 1, 2, 3, 4, and 5 visits
Percentage of ESI level 1, 2, 3, 4 and 5 visits
Median time in waiting room
Number of patients who left against medical (AMA) advice
Percentage of of patients who left AMA

9. Data Collection HOQRS data was used to evaluate:
OP-18a: Median Time from ED Arrival to ED Departure for discharged patients (overall)
OP-18d: Median Time from ED Arrival to ED Departure for discharged ED patients (Transfer Patients)
OP-20: Median Time for Door to Diagnostic Evaluation by a Qualified Medical Provider
OP-21: Median Time to Pain Management for Long Bone Fractures
OP-22: Number of patients that left without being seen

10. Results Data represents 196,970 separate ED evaluations
In 2013, there were 82,917 visits to FEDs affiliated with the Cleveland Clinic, Baylor, and University of Utah
In 2014, there were 114,053 visits to FEDs affiliated with the Cleveland Clinic, Baylor, University of Utah, and Northwell Health.

11. Results 1 = Emergency Department Benchmarking Alliance
2 = Hospital Compare Data

12. Results 1 = Emergency Department Benchmarking Alliance
2 = Hospital Compare Data

13. Results

14. Limitations

15. Limitations
No privately owned FEDs participated (they are not required to submit data to HOQRS)
We attempted to obtain data from HOQRS for acute coronary syndrome and stroke but there was insufficient or incomplete data
Bias due to being all academic FEDs

16. Conclusion Academic FEDs meet CMS criteria for long bone fractures.
They have shorter wait times, and higher patient satisfactions when compared to national averages for 2013 and 2014.