Clinical differences between visits to adult freestanding and hospital-based emergency departments

Objective: Compare clinical characteristics for adult visits to freestanding emergency departments (FEDs) and a hospital-based ED (HBED). Methods: Electronic health records were collected on adult ED visits from 7/1/14 to 6/30/15 from three FEDs and one level 1 trauma tertiary care HBED. Results: There were 55,909 HBED visits; 44,108 FED visits. The FED population was slightly more female (61% vs 57%), younger (48 vs 46 years), white (86% vs 60%), and employed (67% vs 49%). A higher percent of FED visits had private insurance (43% vs 20%); a lower percent had Medicaid (25% vs 42%) and Medicare (23% vs 30%). The top three presenting problems were the same at the HBED and FEDs, but the order differed: gastrointestinal (HBED 19% vs FED 18%), cardiorespiratory (18% vs 16%), injury-pain-swelling of extremity (14% vs 17%). Differences were seen in primary ICD9 codes. One quarter of FED visits and only 18% of HBED visits were for injury/poisoning. A higher percent of FED visits were for respiratory diseases (12% vs 9%) but a lower percent were for circulatory system diseases (7% vs 11%) and visits for mental illness (2% vs 6%). Nearly 30% of HBED visits resulted in admission, compared to 8% of FED visits. ESI level differed significantly, with a lower percent of high acuity cases at FEDs (level 1: 0.1% vs 1.6%; level 2: 5% vs 26%). Conclusion: Differences were observed in clinical characteristics of adult HBED visits versus FEDs. Results of this study can help communities plan their emergency care system. (C) 2018 Elsevier Inc. All rights reserved.