Freestanding emergency departments in Texas do not alleviate congestion in hospital-based emergency departments.

Objectives: Ever since the passage of the Texas Freestanding Emergency Medical Care Facility Licensing Act in 2009, freestanding Emergency Departments (FrEDs) have spread throughout Texas. This study aims to determine whether the entry of FrEDs has been associated with less congestion in hospital-based EDs.
Methods: The dependent variables of interest were hospital-based ED annual visit volume, median wait time, length of visit for discharged patients and the percent of patients who left without being seen (LWBS). The explanatory variables of interest were the numbers of FrEDs within the same local market of each hospital-based ED, and an indicator variable for whether the hospital owned satellite FrEDs in outlying areas.
Results: Hospital ED visits, wait times, length of visit for discharged patients, and LWBS rates were not associated with the number of competitor FrEDs in the local market. Hospitals that opened satellite FrEDs had significantly higher visit volume in general, but did not experience shorter wait times, length of visit or LWBS rates if located in large metropolitan areas.
Conclusions: The entry of FrEDs did not help relieve congestion in nearby hospitals in major metropolitan areas in Texas. By offering more treatment options to patients, FrEDs are associated with increased usage of emergency services.
Competing Interests: Declaration of Competing Interest YX reports no conflict of interest. VH reports that she is a volunteer member of the Board at Community Health Choice.
(Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)