Freestanding EDs – either satellite branches of hospitals or independently operated facilities – have popped up across the United States. Texas has the most, with 338 freestanding EDs as of May last year, and these facilities handle nearly one-quarter of all emergency department visits in the state.

“Freestanding healthcare facilities were intended to provide more cost-effective and convenient alternatives to hospital EDs, but this has not turned out to be the case, according to the existing research,” said corresponding author Daniel Marthey, from Texas A&M University. “The costs are about the same, as is the volume at hospital EDs.”

Marthey said previous research found that spending on Medicare, the US health insurance programme, increased after urgent care centres – which don’t have the capabilities of a fully equipped emergency room and are not open around the clock – sprung up. It’s likely that these centres were entry points for hospital services, despite having lower costs.

“While useful, previous studies use payer-specific data and only observe the subset of urgent care centres, leaving important gaps in our understanding of how patients in Texas use all freestanding EDs,” Marthey observed.

For this study, the researchers compared patient and visit characteristics at satellite and independent freestanding EDs and hospital EDs in Texas in 2021–2022 using publicly available Texas Emergency Department public use data files. They used a descriptive analysis with chi-square tests to compare patient and visit characteristics at satellite and independent freestanding EDs and hospital EDs.

They ranked the top 20 diagnoses and procedures by volume, treatment intensity and potentially avoidable ED use. Discharge data from 2021 to 2022 was combined for the analysis, and ED data at critical access hospitals was excluded. The study sample consisted of 21.6 million ED visits, with 76 per cent occurring at hospitals; 12 per cent at satellite freestanding EDs; and 12 per cent at independent freestanding EDs.

“In short, we found that nearly 24 per cent of all ED visits occurred at satellite and independent freestanding EDs,” said co-author Benjamin Ukert, also from Texas A&M University. “These patients were younger, healthier and less likely to be identified as non-Hispanic Black or Hispanic. They also were more likely to have private insurance and their visits were more likely to be due to issues that could have been managed in a primary care setting.”

Patients at satellite freestanding EDs more closely tracked the population treated by their hospital counterparts. The health issues of patients visiting satellite and independent freestanding EDs were more likely to be moderate and low intensity, and potentially avoidable. Visits at these facilities were more likely to be respiratory related, to lead to more procedures that involved testing for Covid-19, and more likely to be classified as being of moderate and low-intensity severity.

“Freestanding emergency departments have become an important source of emergency medical services in Texas,” Ukert reasoned. “This study underscores the need for researchers and policymakers to consider the role of freestanding EDs on inpatient services and other factors affecting the volume of hospital emergency room services.”

Student Maya Ramy, from the Texas A&M School of Medicine, also co-authored the study, which was published in Health Services Research.