Who do freestanding emergency departments treat? Comparing Texas hospitals to satellite and independent freestanding departments in 2021 and 2022

Abstract

Objective

The objective was to describe characteristics of emergency department visits to Texas satellite and independent freestanding emergency departments (FrEDs) relative to hospital emergency departments (EDs).

Data Sources and Study Setting

The study used all 2021–2022 hospital and FrED discharges from the publicly available Texas Emergency Department Public Use Data Files (PUDF).

Study Design

We conducted a descriptive analysis, comparing patient and visit characteristics at satellite and independent FrEDs and hospital EDs using chi-square tests. We characterized the top 20 diagnoses and procedures ranked by volume, treatment intensity, and potentially avoidable ED use.

Data Collection/Extraction Methods

Discharge data from 2021 to 2022 were combined for the analysis, and ED data at critical access hospitals were excluded.

Principal Findings

Our sample consisted of 21,605,421 ED visits, 76% occurring at hospitals, 12% at satellite FrEDs, and 12% at independent FrEDs. Compared with hospitals and satellite FrEDs, patients to independent FrEDs were younger, healthier, more likely covered by private insurance, and less likely to be identified as non-Hispanic Black or Hispanic. Visits at satellite and independent FrEDs were more likely to be of moderate and low intensity and potentially avoidable.

Conclusions

Our results underscore the need to address potentially avoidable utilization of emergency services.