Need the Emergency Room? Skip the Wait

The Emergency Health Centre near Houston calls itself a ''concierge'' facility.

A big "EMERGENCY" sign on a medical building has always stood for certain predictable things, including round-the-clock medical treatment for anything that ails you—albeit on a "most sick, first served" basis—and long hours in crowded waiting rooms for people with less than dire medical problems. So Birgit Aarrestad was relieved when she and her daughter, who was in excruciating pain from a nasty ear infection, rushed to the emergency room in their Seattle suburb and were whisked into an exam room right away. Nurses gave her daughter a Beanie Baby to calm her cries, a doctor examined her ears within minutes, and—prescription drops in hand—the family was home in an hour.

At most of the nation's 4,500 or so hospital emergency rooms, the old ways still rule. But a new type of emergency facility is emerging across the country, one that isn't located at a hospital at all and whose claim to fame is customer service. Often situated in the fast-growing suburbs, these "freestanding" emergency rooms trumpet shorter wait times and a more pleasant environment and, at their best, bring much-needed emergency diagnostic and clinical expertise to underserved areas. Typically staffed by board-certified emergency physicians, they're equipped to evaluate, stabilize, diagnose, and treat patients with conditions as varied and serious as broken bones and severe burns. They currently operate in only about 16 states, so they're not commonplace yet. But their numbers are growing fast. Between 2005 and 2006 alone, the total grew more than 20 percent, to 179, according to the American Hospital Association.

"We see it as a positive trend, an effective way to meet increased ER needs without adding hospital beds," says Caroline Steinberg, vice president for trends analysis for the AHA.

Clearly, their services are needed. A series of three reports by the Institute of Medicine in 2006 described a litany of problems with U.S. emergency care. Forty percent of ERs are overcrowded on a daily basis. Patients who need to be admitted to the hospital wait hours—even days—for a bed to open up. Ambulances diverted to less crowded ERs lose precious minutes. The problem is partly one of increased demand: In 15 years, the number of emergency department visits increased 25 percent, to 118 million in 2006, as both insured and uninsured people increasingly have come in for even their primary care. At the same time, the number of hospital emergency departments shrank from more than 5,100 in 1991 to just under 4,600 in 2006 as hospitals cut costs and insurers slashed reimbursements.

A caveat. But some experts worry that patients dreading a wait may not realize that, in certain instances, it's smarter to head for the hospital. "The downside of freestanding emergency departments is that you don't have immediate access to backup consultation [with specialists] or access to operating rooms that the most severe injuries require," says Arthur Kellermann, professor of emergency medicine at Emory University's School of Medicine and a member of the IOM committee that published the series on emergency care.

Catering to a mostly insured, affluent clientele, freestanding emergency rooms aim to smooth away the rough edges of an ER visit while providing top-notch care. The website for the Emergency Health Centre in the Houston suburb of Willowbrook, for example, advertises itself as the country's first "concierge emergency medicine facility" and boasts a "comfortable and luxurious environment" as well as online check-in and quick service. It sounds more upscale spa than medical facility. Aarrestad, now a veteran of several visits to the freestanding ER near her home in Issaquah, Wash., marvels, "I've never seen anyone in the waiting room."

Well equipped. Despite placing a premium on customer service, freestanding emergency rooms shouldn't be dismissed as lightweights at medical care, say experts. The vast majority are operated by hospital systems, and all must have agreements to transfer patients to a hospital when necessary. The Issaquah facility is part of Seattle's Swedish Medical Center, for example, a group of three hospitals and several primary and urgent care clinics. The trip from Issaquah's ER to the hospital downtown takes 15 minutes "with sirens blaring," says John Milne, medical director for strategic development for Swedish Medical Center. The facility is equipped with diagnostic tools like X-ray, CT scan, MRI, and ultrasound equipment as well as an on-site lab, available 24-7. The medical staff can handle bad cuts and burns, broken bones, allergic reactions, and food poisoning, among other things, just like a regular ER. "The difference is that I don't have inpatient rooms or operating rooms," says Milne. "If you need admitting or surgery, you are transferred."