What is a Free-Standing ER?

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This guide is intended to describe a new healthcare delivery facility called the “Free-Standing ER”. Free-Standing ERs are so new that they have many different names including: Satellite ERs, Freestanding Emergency Centers, FECs, FSEDs, and remote ERs. The name “Free-Standing ER” best describes this new facility type because it is a fully staffed and fully equipped 24/7 Emergency Room that is not physically attached to a hospital.

Back in the 1970’s and 1980’s

Historically, healthcare was much simpler. Doctors worked in both the hospital and had their own office. Family doctors would frequently do surgery, deliver babies and everything in between. Young doctors just out of school were obligated to work in the hospital’s emergency department. These young doctors were required to work in the ER to gain experience and to obtain their hospital credentials. As time went by and their experience grew these young doctors would then be allowed to stop working in the hospital’s ER and focus on building their practice.

As the field of medicine progressed and more information and treatment techniques became available, physicians began to specialize. Family doctors stepped aside and allowed Obstetricians to deliver the babies and surgeons to do all of the surgeries. This specialization brought better outcomes for patients. Hospitals eventually stopped requiring the new inexperienced doctors to first work in their ERs.

Some doctors preferred working in the ER. This lead to the specialty of Emergency Medicine. As this specialty’s knowledge base has grown, the quality of Emergency care has greatly improved. Emergency doctors became able to render more and more care in the ER. The field of Emergency Medicine has continually been faced with very strong economic forces and hospital overcrowding. Admitting patients to the hospital has become more and more difficult. Thankfully, advancements in technology, our understanding of disease and emergency conditions has allowed Emergency Physicians to be able to treat patients in the ER and send them home without admitting them to the hospital. Today many patients that would have required admission to a hospital 10 years ago are instead rapidly treated in the ER and safely discharged home. A tremendous amount of treatment now occurs within the ER.


Most ERs now “treat and street” close to 90% of their patients. With hospitalization costs so high this saves patients a tremendous amount of money. Only patients that require hospitalization are admitted. This has helped decrease healthcare costs but this has also caused patients to undergo extensive work ups and time consuming treatments in todays’ ERs. Many patients do not have a primary care physician and/or do not have health insurance. The ER has become some patients’ source for primary care. These factors have lead to the nationwide problem of ER overcrowding. Unfortunately, this overcrowding leads to unreasonable wait times and poor care. The medical-legal literature is riddled with bad outcomes associated with long waiting times in Hospital based ERs.

This situation has frustrated many patients and healthcare professionals. Hospitals have hired consultants, midlevel providers, more staff, built larger ERs and anything else they could to attempt to keep up with the demand for Emergency Medicine. Unfortunately the problem of ER overcrowding is only getting worse. With the government now requiring the use of cumbersome computer data entry with every aspect of patient care the speed of the healthcare delivery has gotten even slower and more frustrating. With the Affordable Care Act now being implemented it is estimated that the ER overcrowding problem will be astronomically worse.

Why Freestanding ERs developed

Free-Standing ERs were developed to increase the quality of healthcare that is available to patients, decrease patient wait times, and lessen hospital ER overcrowding. Freestanding ERs are smaller than hospitals and are generally located closer to many patient’s homes. The staff of the Freestanding ER has much more control over their operations and can maximize the performance of the treatment of their patients. Freestanding ERs bring the full brunt of Modern Diagnostics and high level staffing to patients’ neighborhoods. Freestanding ERs have gotten rave reviews by patients.

Free-Standing ERs have been shown to increase patient’s access to care, increase the quality of care, offer zero wait times, less risk of medical errors, less risk of hospital acquired infections, highest patient satisfaction scores and the highest employee satisfaction scores. It is no wonder why Patients, Nurses, and Physicians have given the Free-Standing ER facilities rave reviews.

Freestanding ER

Freestanding ERs currently have many different names, such as Freestanding Emergency Center, Freestanding Emergency Department, Freestanding ER, FSED or FEC. Essentially, a freestanding ER is a fully functional ER that is not attached to a hospital. Grossly compared to Hospital based ERs Freestanding ERs have the same diagnostic equipment (Cat Scans, x-ray, lab) and the same staff (Emergency Physicians, Nurses, Lab and Radiology Techs) and are open 24 hours a day 7 days a week. A more detailed look at Free-Standing ERs reveals that most states require higher levels of staffing at Freestanding ERs than what is required at hospital based ERs. Furthermore, most states require more intense engineering and architecture in Free-Standing ERs than is required in hospital based ERs. For example, the treatment spaces in Free-Standing ERs are under the same positive pressure airflow and bacteriostatic monolithic flooring requirements as Hospital Operating Rooms. These requirements greatly reduce patient’s risks of contracting an infection FROM their ER visit.

How is a Freestanding ER different from an Urgent Care?

With all of the different names for Freestanding ERs it is no wonder that some patients can be confused about the difference between Freestanding ERs and Urgent Cares. Freestanding ERs are licensed by the State and are required to have Emergency Physician and Nursing staff, be open 24 hours a day 7 days a week, have transfer agreements with hospitals, and have the same diagnostic capabilities as hospital based ERs. The design and engineering of Freestanding ERs is also required to equal that of hospitals. For example, freestanding ERs are required to have covered Ambulance entrances and covered patient entrances. In fact, each treatment room in a freestanding ER must meet stringent code requirements, like having a minimum amount of light in each room and positive pressure airflow. Freestanding ERs are required to have an engineering office, break down areas for supplies, medical gas rooms, and all occupied spaces must have a sprinkler, often including the outside ambulance bays. The physical plant requirements of Freestanding ERs are similar if not more stringent than that of hospitals.

Urgent Cares have variable hours, staffing, and diagnostic equipment. Urgent Cares are not required to meet the same codes as Freestanding ERs. Urgent Cares are not open 24/7. As a result Urgent Cares are much cheaper to build, staff and operate. This explains why Urgent Cares may be able to charge less for their services than Freestanding ERs. Since Freestanding ERs must meet or exceed the licensure requirements prescribed for Hospital Based ERs, they typically charge the same as Hospital ERs.

It is important that Freestanding ERs and Urgent Cares work together to lower patients’ costs while offering a higher quality of care. Freestanding ERs will often refer patients to Urgent Cares for treatment when an “Emergency Treatment” is not required. Urgent Cares will often refer patients to Freestanding ERs when patients need “Emergency Care”.

Why do Patients Prefer Freestanding ERs

Rather than going to hospital based ERs, experience is showing that patients prefer going to freestanding ERs. This is happening all over the country. Freestanding ERs typically have little to no wait time and are very close to patients homes. In fact, most freestanding ER patients are “Treated and Streeted” in 1/2 the time that most Hospital based ER patients spend waiting in the waiting room.

The entire staff at freestanding ERs are typically very experienced in Emergency Medicine. Patient’s treatment and diagnosis typically benefit from the high amount of experience found in the staff of Freestanding ERs.

The staff at Freestanding ERs enjoy much higher job satisfaction and are able to spend much more time caring for the patients. With this high job satisfaction most of the Freestanding staff stay at the Freestanding ER which leads to much less turnover in staff. This equates to repeat ER patients actually forming a relationship with the staff.

Do Freestanding ERs accept Ambulances?

All Freestanding ERs are capable of accepting Ambulance Patients. The area of Freestanding Emergency Medicine is still evolving and therefore different areas and EMS systems currently treat Freestanding ERs differently.

When the staff determines that Freestanding ER patients need to be admitted to the hospital, the patients are typically taken by Ambulance to a hospital room, operating room or heart cath lab for further treatment and admission. Patients roll down the highway instead of rolling down the hallway into the hospital, bypassing the hospital based ER.

2 Responses

  1. I only recently heard about freestanding emergency rooms the other day in passing. I wish I had heard about them sooner! I am really excited by the fact that they tend to have less volume than ERs attached to hospitals. I will definitely look for a freestanding ER in our new town. I have kids so less time spent waiting is a very good thing!

    • Nathaniel Greenwood

      Tara, Thank you for your observations. It’s truly a wonderful thing to provide quality access to care. If you don’t mind me asking, where are you living? I may be able to provide insights to you regarding future freestanding ERs near you.

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