Need the Emergency Room? Skip the Wait

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

Certain "time-critical issues," such as heart attack, stroke, and significant trauma from a bad car crash, say, are thus better directed to a traditional ER in the first place, says Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems and member of the IOM committee. If you walk into a freestanding ER with chest pain and it turns out you're having a heart attack, for example, the staff at a freestanding facility can evaluate and stabilize you, but you'll likely have to be transported to a hospital with a cardiac catheterization lab for treatment. Why not just start out at the facility with resources you may need? On the other hand, if you have to be transported from a freestanding ER, you'll probably be whisked straight from the ambulance into the cath lab, losing little time, say fans of freestanding ERs. They point out that cooling your heels in a crowded hospital emergency room while you wait to be evaluated isn't exactly good for you.

When in doubt, dial 911, experts advise; the emergency medical services team can evaluate where it's best to take you. Many EMS operations refuse to deliver patients to freestanding emergency departments because they don't want to have to transfer a patient twice. "A secondary transport will compromise patient care," says Elizabeth Calzadilla-Fiallo, spokeswoman for the Miami-Dade County Fire Rescue Department, which won't deliver patients to freestanding facilities.

There's another potentially confusing issue for patients: Only 70 percent of freestanding emergency departments are open 24 hours a day, according to an American Hospital Association survey. They may close their doors during the middle of the night, the very time when patients are most likely to count on an emergency department being open. (More information about what to ask, before catastrophe strikes, click here.)

Practical considerations aside, some practitioners and health policy experts are concerned that building freestanding emergency facilities in suburban areas isn't a smart use of scarce resources. "At their worst, [the facilities] reflect a further segmentation of a healthcare market that is focused more on providing care to those who can pay, whether or not they need it, than on those who need it, whether or not they can pay," says Kellermann. But for the fortunate few, medical misfortune is getting a little easier to bear.