Free-Standing Emergency Departments

Free-standing emergency departments (FSEDs) are on the rise. Unlike urgent care clinics, these facilities are designed to replicate the full array of services and procedures offered by traditional hospital emergency departments. Most accept ambulance traffic. However, FSEDs cannot admit patients for inpatient care. When such care is needed, the FSED must transfer the patient to a hospital with which it has a written transfer agreement.

The development of FSEDs is driven by growing population trends in urban and suburban communities, demand for more convenient care closer to home, and a dwindling number of hospital emergency departments despite the growing need for emergency care. From 1995 to 2005, the number of emergency rooms (ERs) in the United States decreased from 4,176 to 3,795.

FSEDs currently are not licensed in Texas. The Department of State Health Services (DSHS), which licenses and oversees other types of health care facilities, has no authority to regulate them. FSEDs can pursue accreditation by the Joint Commission and other accrediting organizations, but that process is voluntary. Without a regulatory framework in Texas, there is neither a common definition of FSED nor a minimum set of standards by which each facility must abide.

In 2007, legislation was filed to define the minimum operating criteria for FSEDs as well as to establish regulatory authority. TMA strongly supported the legislation. The bill stalled because of differences over whether FSEDs must be open 24 hours a day, seven days a week.

Medicine's 2009 Agenda

  • Support measures to establish the minimum operating criteria and regulatory framework for FSEDs

Medicine's Message

  • Facilities marketed as "emergency departments" should be open whenever there is a potential health care emergency, which means that coverage is provided 24/7.
  • FSEDs have the potential to relieve hospital ER overcrowding and to increase the availability of high-quality emergency care where such care is not readily available.
  • The public must trust that FSEDs provide the same level and quality of care as hospital-based emergency departments and that they meet the public's expectations of what an emergency care facility can provide.
  • To ensure that FSEDs provide safe, high-quality, and appropriate emergency care, minimum operating criteria should be established.
  • The need for emergency room services is growing in the United States. From 1995 to 2005, ER visits increased 31 percent.