October 2, 2017

Freestanding ED Research Update: AJEM Article

When the FEC Section of ACEP was founded in 2014, one of our major goals was to do the following:

“Educate ACEP members, the medical community, and the public about what FECs are, what they do, and how they fit into the patient’s circle of healthcare providers.”

To do this effectively, we need to collect data about how our FSEDs are performing, and how that compares to traditional EDs. With this in mind, Dr. Erin Simon, from Cleveland Clinic-Akron, Dr. Cedric Dark, from Baylor, and Dr. Eric Cruzen, from Northwell Health, and I did a retrospective chart study analyzing wait times, treatment times, metrics reported to the Center for Medicare and Medicaid Services (CMS), and patient satisfaction scores at 8 FSEDs affiliated with academic institutions.

Our hypothesis was that that FSEDs helped fulfill the first goal of the Institute for Healthcare Improvement (IHI) Triple Aim Initiative to “improve the patient experience of care (including quality and satisfaction).”

We evaluated data from our cohort of 8 FSEDs including information from Electronic Health Records (EHRs), CMS reports, and Press Ganey publications. We compared our findings to national averages of traditional EDs using CMS reports, and we compared our findings to EDs with a similar census using data from the Emergency Department Benchmark Alliance (EDBA). Our study involved 147,053 patient visits from 2013 and 2014. The study was published in the American Journal of Emergency Medicine.

Compared to both traditional EDs and EDs with a similar census, our cohort of FSEDs showed the following:

Metric: Wait Time
Study Cohort FSEDs: 10 minutes
National Average: 16 minutes
ED with Similar Census: 13 minutes

Metric: Treatment Time for Discharged Patients
Study Cohort FSEDs: 142 minutes
National Average: 147 minutes
ED with Similar Census: 121 minutes

Metric: Percentage of Patients who Left Without Being Seen
Study Cohort FSEDs: 0.4%
National Average: 2.1%
ED with Similar Census: 1.6%

Metric: Time to Pain Management from Broken Long Bone
Study Cohort FSEDs: 50 minutes
National Average: 53 minutes
ED with Similar Census: NA

Metric: Press Ganey Patient Satisfaction Percentile
Study Cohort FSEDs: 91.54%
National Average: 50%
ED with Similar Census: NA

We also found that there were fewer ESI Level 1 (resuscitation) cases (0.2% vs. 2%), but there were also markedly fewer ESI Level 5 (Non-Urgent) cases (4.1% vs. 25.4%):

Based on these results, we concluded that with shorter wait times, similar treatment times, and higher satisfaction scores, our cohort of FSEDs satisfied the 1st goal of IHI’s Triple Aim of “improving the patient experience of care.”

We would like to do a similar study using both independent and HOPDs. This second study will feature treatment times, but will also focus on insurance reimbursement and integration with the local EMS system.

If you are interested in being involved, email me today.

If you have any newsletter comments or suggestions, or would like to contribute an article, please email me.

Erin L. Simon, DO, FACEP
ACEP FEC Secretary