Maureen Fuhrmann MHA, BSN, RN
Chief Business Development Officer of Neighbors Emergency Center
When one is in medical distress, it is natural to think of going to the closest hospital-based emergency room. In the past, this was the only option. Now things have changed, and taking the time to understand the options can help someone with a medical crisis access care in the fastest way possible.
Freestanding emergency centers (FECs) are fully functioning ERs that provide care at the same level as a hospital-based ER. There are more than 200 of these facilities throughout Texas, and more are located in the Houston area than anywhere else in the state. Although most patients are treated and discharged directly from both FECs and hospital-based emergency departments, these facilities also treat patients who require additional services outside of the emergency department. Some FEC patients need to be admitted to the hospital just like those treated in a hospital ER. Understanding how the admission process works for both FECs and hospital-based ERs, and the unique benefits of being directly transferred to inpatient services from an FEC, can help individuals make the right choice in an emergency.
Transfer Agreement and Memorandum of Transfer
Before opening, all FECs secure a transfer agreement to work with nearby hospitals to coordinate care and ensure a smooth transfer when inpatient services are needed.
A memorandum of transfer (MOT) will tell the patient where they are being transferred, why they are being transferred, and the risks and benefits of the transfer. The MOT will also note who the accepting physician is at the inpatient facility. Before the MOT is valid, it requires signatures from a physician at the FEC stating that the patient is stable enough to be transferred, as well as a signature from both the patient and the physician who will be treating the patient at the higher level of care. Patient transfer costs vary, but on average cost approximately $500. This cost, which stems primarily from the ambulance ride, is typically covered by insurance.
The partnership between FECs and hospitals allows for an easy transition process and efficient transfer of patient information from one facility to another. This strong working relationship between hospitals and FECs helps to ensure Texans receive the highest quality care possible.
Reasons for Transfer
It is important to remember that an FEC has the same equipment and capabilities as a hospital-based ER. The only time a patient would require a transfer from an FEC is when the patient needs inpatient services that aren’t provided in an ER setting. For example, if a patient has a condition that requires surgery, the patient would be stabilized at the FEC and then admitted to the hospital for the surgical procedure. Admitted patients are rarely transferred from the FEC into a hospital-based ER, but instead go directly into the inpatient portion of the hospital. When a patient needs to be admitted from a hospital-based ER, they follow this same process and transfer the patient to the inpatient department of the hospital; the significant difference is FECs transfer patients via ambulance while hospital ERs typically transport the patient on a stretcher.
However, some hospital-based ERs do transfer patients via ambulance if their facility does not provide the level of care the patient needs. In such cases, the patient would need to be transferred to another facility that offers a higher level of care. For example, many hospitals struggle to maintain neurosurgery and certain types of orthopedic coverage. Patients requiring these services who visit a hospital-based ER may require an ambulance transfer to another hospital, just as they would if they visited an FEC.
Benefits of FEC Transfers
The wait times at traditional hospital-based ERs are much longer when compared to FECs. For patients who present initially at a hospital-based ER, these long waits prolong the process of seeing a physician and being admitted to the inpatient part of the hospital.
A typical hospital-based ER can see as many as 180-200 patients per day, and the majority of those patients don’t display obvious outward signs of an emergency. A patient can sit in the hospital ER for hours believing they have indigestion, and end up having a heart attack in the waiting room. In an FEC setting, the same patient would be in the FEC exam room in less than 10 minutes on average.
In many cases, FEC patients can be seen by a physician, diagnosed, and transferred to a hospital in a shorter amount of time than if the patient had gone straight to the hospital-based ER. It’s the short time between door to diagnosis at FECs that saves patient lives, along with the efficiency of FEC transfers if a patient requires a higher level of care. This is another example of how the FEC delivery model is revolutionizing healthcare and improving patient outcomes.