title: The impact of two freestanding emergency departments on a tertiary care center.
abstract: BACKGROUND
  Freestanding emergency departments (FEDs) have become increasingly popular as the need for emergency care continues to grow.
  
  
  OBJECTIVE
  To analyze the impact of two FEDs on a local tertiary care center's patient volume and admission rates.
  
  
  METHODS
  A retrospective analysis examined monthly volume and admission rates for the main ED and two FEDs located 9.6 and 12 miles away. Main ED census records were divided into three distinct time frames: period A (control) was January 2007 through June 2007. Period B was July 2007 through July 2009 when one FED was open. Period C was August 2009 through June 2010 when both FEDs were open. A two-factor analysis of variance was used to analyze admission rates while adjusting for monthly variation.
  
  
  RESULTS
  The mean monthly patient volume for the main ED was 4709 for period A, but dropped significantly (p<0.01) to 4447 for period B, and again dropped significantly (p<0.01) to 4242 during period C. The volume for all facilities increased throughout the study period. A combined monthly volume increase to 5642 occurred in Period B, and increased to 6808 in Period C. The adjusted mean admission rate at the main ED for period A was 0.221, which dropped somewhat, though not significantly (p=0.3505) to 0.213 for period B, and then significantly (p<0.01) to 0.189 for period C.
  
  
  CONCLUSIONS
  Opening two FEDs decreased the volume and admission rates for the main ED and increased the overall ED volume for the health care system.
authors.affiliation: Department of Emergency Medicine, Akron General Medical Center, Akron, Ohio 44307, USA.
authors.forename: Erin L
authors.initials: EL
authors.lastname: Simon
authors.forename: Peter L
authors.initials: PL
authors.lastname: Griffin
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Jouriles
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006801:Humans; D010343:Patient Admission / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers