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

1 | INTRODUCTION Over the last decade, the number of freestanding emergency departments (FrEDs) across the country has increased substantially. Most growth occurred in Texas, which, as of May 2023, [...]
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. KEYWORDS access/demand/utilization of services, hospitals, independent freestanding emergency departments, state health policies