Freestanding Emergency Department Planning Considerations

Freestanding Emergency Department Planning Considerations

According to recommendations from the American College of Emergency Physicians, all emergency departments should provide services 24 hours a day every day of the week, follow the intent of the Emergency Medical Treatment and Labor Act and be staffed by qualified emergency physicians. This application holds true for both hospital-sited departments and freestanding EDs. A freestanding ED is “a licensed facility that is structurally separate and distinct from a hospital and provides emergency care,” which may be classified as a hospital outpatient department or independent freestanding centers.

While recommendations and codes may be quite similar for both, there are four distinct design considerations for freestanding EDs that may differ from a traditional hospital-sited ED approach.

1. Access: Easy-In and Rapid-Out

Access to a freestanding ED should be straightforward and simple for patients. Unlike a hospital where there are multiple and competing traffic flows, visibility and circulation into the walk-in entry should take a retail approach with very clear signage, close proximity and sightlines from the highway. Access out is more important for transfer patients who have been stabilized, but may need emergency surgery or an inpatient bed. Rapid-out may translate into dedicated ambulance turn lanes to access a hospital faster, and often also comes with a helistop on the site for mitigating road congestion via air transport.

2. Thinking Beyond Code Minimums

Freestanding ED codes generally require at least one airborne isolation room, but that may not be enough, particularly with post-pandemic lessons learned. Most patients in a freestanding ED arrive on their own — 95%, as opposed to 40% for hospital EDs, according to Healthgrades. Isolation options should be considered near the walk-in entry to quickly manage an infectious patient presenting through the front door, as well as near the ambulance entry, depending on departmental size. Most codes don’t mandate direct connectivity between a treatment room and a toilet for an isolation patient or one in observation status. Since patients may be held for 24 hours or more, this nicety enhances safety and privacy.

3. Amenities to Attract and Retain

Return on investment for freestanding EDs is a fine line and the program must be extremely lean, minimizing waste and non-revenue generating space. There are a few places, however, where a small investment in support space can help the bottom line. The first is a nod to the emergency medical services that may bring patients to the freestanding ED via ambulance. A small touchdown space, a nourishment alcove, or access to an exterior board wash down area are nice gestures to support these teams, make their time more productive, and help reinforce that relationship. A second is careful consideration around provider amenities. Active collaboration zones, more private work or telemedicine and respite spaces may aid in retention.

4. Complementary Services

Generally in a hospital, the program for complementary services for an ED is the balance of the hospital departments: imaging, lab, pharmacy, inpatient beds, surgery, etc. For a freestanding ED with no beds or surgery, proper support may help drive business. For instance, some amount of lab and imaging is needed as ancillary support for a functioning ED. If carefully positioned for integration with the ED, along with separate outpatient access, these departments could serve both patient populations. In turn, investments in high-cost technologies — like CTs and chemistry analyzers — could be better utilized all day, particularly during lower ED census times.

Designed with these four planning considerations in mind, a freestanding ED will stand apart and operate differently than a traditional, hospital-sited ED. Appealing to both patients and staff seeking convenience and support, this freestanding ED model can really differentiate their experiences.

Katie Fricke
Health Planning Principal