TITLE: Resolution for Freestanding Emergency Departments (FSED):

Whereas, in 2016 there were 387 hospital-based freestanding emergency departments (FSED) and 172 independent for-profit freestanding ED’s within the U.S. constituting an increase of 76% between the years of 2008 and 2015 (Freestanding EDs Growing in Popularity, 2017).

Whereas, the existence of FSED’s is on the increase, with a sustained purpose to provide premium emergency care to our community-based patient populations, and they are an integral part of our emergency healthcare delivery systems.

Whereas, the freestanding emergency rooms offer a new concept of emergency care, and provide a niche emergency care service to our community-based communities.

Whereas, it has been identified that due to the variable states of resources, staffing, and professional certifications within these FSED environments, there may exist an increased risk of negative patient outcomes (Freestanding EDs Can Have Special Compliance, Liability Concerns, 2017).

Whereas, the role of the freestanding ED’s is confusing for many members of our patient populations, the public has specific expectations of emergency rooms capabilities, and the emergence of a new care model is confusing to our patients.

Whereas, emergency medical systems (EMS) have already determined the patient population needs, the capabilities of the various FSED’s within their respective service areas, and have categorized the FSED’s to most effectively utilize the FSEDs’ services within their areas (Lawner, Hirshon, Comer, Nable, Kelly, Alcorta, & Browne, 2016).

Whereas, violence within the emergency room continues to increase, and the safety of the medical personnel in the community FSED’s is of utmost importance.

Resolved, that ENA promote the standard of care for FSED meet the same standard as emergency departments as outlined by the ENA.

Resolved, That the Emergency Nurse Association governing board of trustees and its membership is in support to implement minimum standards of care for safe patient care and outcomes.

Resolved, That the emergency Nurse Association will assist with community education and promote and disseminate literature describing the differences between FSED’s and urgent care centers.

Resolved, That the ENA collaborate with other organizations such as ACEP, and the National Association for EMS Physicians and regional advisorycouncils to develop a planto incorporate FSEDs to best serve our emergency patient populations.

Resolved, That the Emergency Nurse Association will assist with and develop a clear, strict security protocol to sustain a safe work environment for all FSEDs’ personnel, and that the ENA encourage FSEDs to adapt and follow the ENA and AONE Guiding Principles Mitigating Violence in the Workplace.

Resolution Background Information

The Texas State Council has created a Freestanding ED (FSED) task force to address the rapid emergence of freestanding emergency departments in the State of Texas. Texas State Council had our first meeting in January of this year, and recognize the immense desire by our membership (due to an overwhelming attendance) for the ENA to become more involved in the evolution of this new freestanding emergency care model. Next year this task force will become an ad-hoc committee to the Texas State Council. We wish to present our concerns in this resolution to the national ENA membership for the General Assembly’s consideration.

Relationship to ENA Bylaws, Mission, Vision, and Strategic Initiatives

The mission of the Emergency Nurses Association is “to advocate for patient safety and excellence in emergency nursing practice.” The new FSED care model is very new to emergency medicine. It is important to advocate for the patients as the new concept evolves. We don’t want to be “left behind” in this new emerging concept. Other segments of the emergency care business (i.e. EMS systems and governmental agencies, etc.) have already tackled addressed the FSED’s concept – it is the authors’ opinion that it is time for ENA to become involved.

References

Freestanding EDs Growing in Popularity. (2017). Healthcare Risk Management, 39(1), 4-5.

Andrews, M. (2008). A wait at the ER measured in minutes, not hours. A new type of freestanding emergency room promises good medicine plus customer service. U.S. News & World Report, 145(7), 79-80.

Freestanding EDs Can Have Special Compliance, Liability Concerns. (2017). Healthcare Risk Management, 39(1), 1-3.

Lawner, B. J., Hirshon, J. M., Comer, A. C., Nable, J. V., Kelly, J., Alcorta, R. L., & ... Browne, B. J. (2016). The impact of a freestanding ED on a regional emergency medical services system. American Journal Of Emergency Medicine, 34(8), 1342-1346. doi:10.1016/j.ajem.2015.11.042

Freestanding ERs present unique safety concerns. (2016). Briefings on Hospital Safety, 24(3), 1-4.

Gutierrez, C., Lindor, R. A., Baker, O., Cutler, D., & Schuur, J. D. (2016). State Regulation Of Freestanding Emergency Departments Varies Widely, Affecting Location, Growth, And Services Provided. Health Affairs, 35(10), 1857-1866. doi:10.1377/hlthaff.2016.0412

Author

Daniel R. DiDonato, BSN, RN, CEN 569310,218-414-1196

Barrt Hudson, BSN, RN, CPEN 49431, 817-683-7863,

Supporters

Texas State Council, Resolutions Committee