1. Differences in patient-reported reasons for presenting to a freestanding ED compared to a hospital-based ED
May 18, 2017
Ryan C. Burke, MPH

2. Freestanding Emergency Departments (FEDs)
“A facility that is structurally separate and distinct from a hospital and provides emergency care”1
Open 24/7 and staffed by qualified emergency care providers
Popularity and number of FEDs substantially increasing2

3. Why do people come to the emergency department?
Severity of condition (65%)3
Barriers to accessing primary care or outpatient services (79%)3
Referred from doctor (35%)4
Objective: examine if reasons for coming to an ED differ for FED and HBED patients.

4. Methods Questionnaire to eligible patients after triage
Exclusion criteria:
Ambulance arrival
Age<18
Physical or mental inability to understand consent or complete survey
June – August 2016

5. Setting One HBED and 3 FEDs within same health system
Service area is urban-rural mix
Major metropolitan area population of 700,0005

6. Results: Participants
Demographic
Percent of HBED Respondents (N=267)
Percent of FED Respondents (N=318)
P-value
Race/ethnicity
<0.001
White, non-Hispanic
54.2%
86.8%
Black, non-Hispanic
34.5%
7.5%
Other
11.3%
5.8%
Educational attainment
0.001
Less than high school
13.1%
5.1%
High school graduate or GED
37.1%
35.6%
Some college or 2-year degree
35.1%
33.6%
4-year college graduate
10.2%
14.2%
More than 4-year college degree
4.5%
11.5%
Insurance type
Commercial/Private
20.6%
45.9%
Medicaid
48.3%
24.5%
Medicare
19.1%
19.5%
Uninsured
5.3%
4.7%
Unemployed
35.4% 
14.0%

7. Results: Participants
Survey Response
Percent of HBED Respondents
Percent of FED Respondents
P-value
ESI Level
<0.001
Level 1 or level 2
15.7%
2.2%
Level 3
36.3%
38.1%
Level 4 or level 5
47.9%
59.7%
Self-reported severity of condition
0.002
Possibly life-threatening if not treated within 1 hour
4.7%
3.5%
Requiring treatment in the next 1-2 hours to prevent it from becoming more serious or life-threatening
19.2%
10.0%
Very uncomfortable or worrisome, in need of treatment in the next 3-6 hours
34.5%
29.7%
Uncomfortable, in need of treatment today
36.9%
49.7%
In need of treatment within a couple of days
7.1%
Usual place of care
75.6% 
82.7%
0.053
No other ED visits in last 12 months
30.6%
46.6%
Delayed getting medical care in last 12 months
45.0%
33.2%
0.006

8. Percent of HBED Respondents Percent of FED Respondents
Reason for ED Visit
Reason
Percent of HBED Respondents
Percent of FED Respondents
P-value
Believed problem was serious
45.5%
30.0%
<0.001
Could not get appointment with a doctor
15.8%
20.2%
0.196
ED is convenient
10.9%
24.3%
After hours (usual place/doctor closed)
12.4%
19.9%
0.018
Doctor told me to come
20.3%
11.0%
0.003
Don't have a regular doctor
12.8%
9.8%
0.291
Access to labs/other medical tests
4.5%
14.2%
Doctor would have sent me here anyway
6.8%
9.5%
0.290
ED does better job diagnosing and treating
10.1%
0.012
Did not know where else to go
9.0%
5.4%
0.104
Can see a doctor without having to pay first
1.5%
1.6%
1.000

9. Reason for ED Visit: Regression Results
Reason for Coming to the ED
Adjusted Odds Ratio (95% Confidence Interval)
Confounders Included in the Model
Believed problem was serious
2.08 ( )
Patient's doctor made decision to come to ED; usual place of care; race/ethnicity; employment; insurance type
Doctor told me to come
1.91 ( )
Self-reported severity; ESI level; usual place of care; ED visits in last 12 months; education; insurance type
ED is convenient
0.44 ( )
ESI level; Patient's doctor made decision to come to the ED

10. Conclusions
Differences in why FED patients seek emergency care compared to HBED patients.
Patients choose location based on perceived acuity
Convenience more of a factor in FED patients seeking ED care

11. References
American College of Emergency Physicians. Freestanding emergency departments: Policy statement. Ann Emerg Med. 2014;64:562.
Schuur JD, Baker O, Freshman J, Wilson M, Cutler DM. Where do freestanding emergency departments choose to locate? A national inventory and geographic analysis in three states. Ann Emerg Med [epub ahead of print]. doi: /j.annemergmed
Capp R, Rooks SP, Wiler JL, Zane RD, Ginde AA. National study of health insurance type and reasons for emergency department use. J Gen Intern Med. 29(4);621-7.
Lobachova L, Brown DFM, Sinclair J, Chang Y, Thielker KZ, Nagurney JT. Patient and provider perceptions of why patients seek care in emergency departments. J Emerg Med. 46(1):
Annual Estimates of the Resident Population: April 1, 2010 to July 1, U.S. Census Bureau, Population Division. Updated March Accessed February 2017.

12. Co-Authors Erin L. Simon, DO, Natasha Kesav Brian Keaton, MD
Laura Kukral, MBA
Timothy J. Kiss
Jonathan Sanchez, MBA
Nicholas J. Jouriles, MD

13. Questions? Ryan Burke, MPH burker@ccf.org rburke11@kent.edu