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I do around 75% of my clinical time working in a free-standing ED, with the other 25% in the ED at our primary hospital. We staff the ED with the same physicians and PA's who staff the main hospital ED; the only difference is we don't have any residents. As far as EMS we receive ambulances routinely, with specific exceptions written into the EMS protocols (no STEMI's, stroke alerts, traumas, etc). We still get critical medical patients, including cardiac arrests. The acuity overall is probably a little lower than our main hospital (tertiary academic center/level 1 trauma center), but it's fairly similar to my experience in most typical community ED's. We've got most of the typical resources of other ED's (in-house labs, DI including CT and ultrasound).

Overall I like the model. We provide some volume relief for the primary hospital, and the community loves having the option of being seen locally rather than driving into the city. They actually like it so much that we routinely get patients who drive past both of our hospitals just to be seen in the free-standing ED.

 

From a practice perspective, it's the best of both worlds. We've got the autonomy and efficiency that's often found in community ED's, but are backed up by the resources of a major academic institution; patients needing consults or admissions are simply transferred to the mother ship. Feel free to PM me if you've got any other questions.

 

I didn't know that your satellite facility was a stand-alone ED! Somehow I missed that when you told me about it. Nevertheless, that's what I would prefer- attached to an academic, or at least a large inpatient facility.

 

Thanks for the insight everyone- guess I've been in my little inner-city urban ED too long to see some of the advances in other types of environments :D

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The group I will be working for is contracted through Swedish, and runs three different free standing EDs on the east side (WA state, Issaquah, Redmond, Mill Creek)

when they were advertising a few months ago I looked at working there per diem but I'm not ok with presenting 100% of my pts and having a doc also see 100% of my patients. not a model I want to work in so instead I went in the other direction and found a rural e.d. that is solo coverage 12 and 24 hr shifts with low volume and high acuity. pays the same as the swedish position.

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I work at a facility that operates a free-standing ER as well. It is affiliated with a traditional hospital. We have CT, XR, US and lab. We have 2 trauma/major medical rooms. We are about 20 minutes from our main ED. We get ambulances routinely, except, like above, known STEMI and stroke alerts as long as they are stable. We can take traumas, though we tend to divert those to our main ED unless they are unstable. We get plenty of sick patients, including actively seizing adults and kiddos, cardiac arrests, dyspnea, etc. The majority of our patients are admitted to our main hospital directly (we just consult the hospitalist as we would with our admits at the main hospital). We have a contract with an ambulance company to transport. Of course, we can transfer the patient to what ever hospital they want, even if outside our network, provided there are beds, etc. We are typically fairly busy, seeing approx 90 pts/day (total of 10 rooms plus the major medical rooms). The same PAs/docs that staff our main ED staff the stand alone ED. Docs do 12s (6-6) and PAs are there 1-11.

I honestly love the model. Things routinely get done much faster. Its a good mix of patients. And very much like a typical community ED.

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when they were advertising a few months ago I looked at working there per diem but I'm not ok with presenting 100% of my pts and having a doc also see 100% of my patients. not a model I want to work in so instead I went in the other direction and found a rural e.d. that is solo coverage 12 and 24 hr shifts with low volume and high acuity. pays the same as the swedish position.

 

I imagine with your years experience this could be less than desirable. I feel this position will allow me some better exposure for a couple of years, putting me at the 5 yrs Emed mark. I am currently in VA, and the PAs when working the main ED see high acuity Pts with little oversight, and though this has been a great learning opportunity I feel getting back to Seattle is a better option. So I will present all of my Pts to the Doc and hopefully continue to learn. I will reevaluate at the 2 yr mark or there abouts. Perhaps after 5 yrs all ER medicine I will feel more comfortable in a rural ER.

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I work at the freestanding ER in Newport News that a previous poster mentioned. Our group covers this facility (24 hour MD and APPs from 9a-midnight) as well as the fast track and main treatment area in the main hospital a few miles away (MD 24 hours and APP approx 20 hours coverage). We do NOT accept EMS patients at this freestanding facility. We will accept transfers from a local group called "Patient First" and we have a transportation team available at all times for any stable patients that need to be transferred. We have CT, ultrasound in addition to the usual labs and plain X-rays 24/7, and MRI during usual daytime hours. Hyperbarics is in a neighboring building but we don't send patients to them (a couple of our docs actually work in the hyperbarics office). For emergency hyperbaric needs patients go one of the hospitals in VA Beach. We are set up to take STEMIs, imminent deliveries, and other critical patients but if they are truly critical, we stabilize and call 911.

There are 2 other local freestanding EDs and both of them DO take EMS. Why we do not, I am not really sure. I've 'heard' its because of our proximity to 3 other EDs that there is not a 'need'.

 

I really like it there. It's like being on vacation at work...if there is such a thing LOL. Its like controlled chaos :)

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