In March 2022, Pennsylvania health officials established criteria for hospitals to create outpatient emergency departments (OEDs).
An OED offers emergency care with no on-site inpatient or surgical services. If a patient needs to be admitted, they are transferred to a licensed hospital within 35 miles of the OED.
The OED model enables hospitals to continue to provide care for life-threatening situations in communities where full-service facilities are not feasible. OEDs can be especially valuable in rural areas that are in danger of losing facilities.
“From our standpoint, we now have the opportunity to maintain an ED presence in a rural location ,” says Dr. Jeffrey Muenzer, MD, medical director, Emergency Services, UPMC Lock Haven and UPMC Williamsport. “Otherwise, that ER could have potentially closed and then you’d have to drive 30 miles to go to the larger hub.
“We can see anything and everything that we were before inside the ED. Nothing really changes. The only thing that changes is if a patient has to be admitted now, they get transferred.”
Learn more about OEDs, including the criteria, the care they provide, and potential benefits to communities.
Criteria for Outpatient Emergency Departments
The Pennsylvania Department of Health set criteria that providers must follow to operate an OED.
The most significant requirement is that OEDs must be within 35 miles of a “main licensed hospital.” The main licensed hospital admits patients who need further care after going to an OED. Those patients are transferred from the OED to the licensed hospital. The OED and licensed hospital must have protocols in place to allow for transfers from the OED to the hospital.
OEDs also must be fully integrated with the main licensed hospital. They must follow the same protocols and be part of the same medical record system. Staff members of an OED must be part of the licensed hospital’s staff as well.
Also, OEDs must be able to provide needed care for people who visit. These requirements include:
- Care that is available 24 hours a day, seven days a week.
- At least one doctor and at least one nurse trained to care for emergency patients available at all times.
- At least 10 treatment rooms that have staff and equipment to meet patient needs. Those include rooms to provide care for trauma, obstetrics and gynecology, pediatric, and psychiatric patients.
- On-site imaging services, including x-ray and computed tomography (CT).
- Standard medications, parenteral fluids, plasma substitutes, and surgical supplies to treat immediate, life-threatening conditions.
- Sterile equipment and supplies.
- Lab services.
- Equipment needed to provide drug, blood, and parenteral fluid treatment.
- Common emergency equipment — for example, equipment needed to resuscitate someone whose heart has stopped.
- Food and drink supplies for patients.
Visit the Pennsylvania Department of Health’s website for a full list of the OED criteria.
What Can Be Treated at an Outpatient Emergency Department?
Just as any emergency department does, an OED provides care for life-threatening injuries and illnesses. If you have chest pain, stroke symptoms, or other concerns, you can visit an OED.
The staff includes doctors, nurses, respiratory therapists, technicians, and more — all of whom are trained to treat emergency conditions.
“It’s an emergency department,” Dr. Muenzer says. “We treat anything and everything — life-threatening diseases, injuries. Whatever it is, bring it in. We are happy to see you.”
The only difference in care is that an OED cannot admit patients for further observation or perform surgical services. Patients who need more care are transferred to a licensed hospital within 35 miles of the OED.
“The patients that need to spend a night in the hospital — maybe two — instead of being admitted, they will now all go to the major hub,” Dr. Muenzer says. “Which means they can see some of these specialists in person and a little bit quicker.”
Dr. Muenzer says, in general, few patients who visit an emergency department need to be admitted.
What happens if I need to be admitted at an OED?
OEDs cannot admit patients for further care. But OEDs are covered by a main licensed hospital that can admit patients. In Pennsylvania, the main licensed hospital must be within 35 miles of the OED.
If you visit an OED for an emergency illness or injury and need to be admitted for further care, the staff at the OED will contact the main licensed hospital to begin a transfer. Once a bed is open at the main licensed hospital, EMS personnel will transport you via ambulance to the licensed hospital.
What Are the Benefits of an Outpatient Emergency Department?
The biggest benefit to an OED is that it ensures access to emergency care in rural areas. Many rural hospitals are in danger of closing because of financial reasons.
According to the Pennsylvania Department of Health, at least 120 rural hospitals nationwide have closed since 2010 and 450 are vulnerable to closing. In Pennsylvania, 22% of rural hospitals are vulnerable. An OED is a cost-effective way of making sure rural communities have access to timely lifesaving emergency care. People in those communities don’t have to travel longer distances for care.
“Any opportunity to be in the community and to be within close proximity to sick patients is going to be to their benefit,” Dr. Muenzer says. “If it’s a stroke, time is brain. If it’s a heart attack, time is cardiac muscle. The quicker you can get to an emergency department with any ailment, and the more convenient it is, the quicker we can assess, diagnose, and treat.”
Keeping an OED open in rural communities instead of closing it can have other benefits, too, Dr. Muenzer says. An OED lessens the burden on the main licensed hospital because sick and injured patients can visit the OED instead of the licensed hospital for care.
“If you close down an emergency department or you no longer have the opportunity to have an outpatient ED, you now have all those patients going directly to a major hub. And that’s going to push them to capacity,” Dr. Muenzer says. “Certainly, they would still be able to accommodate anything and everything. But it means that you may have to wait longer to be seen, and there may not be enough beds.”
OEDs also can lessen the burden on local EMS services because they can take patients to the OED instead of traveling a further distance to the licensed hospital.
“If you are requiring that ambulances drive 30, 40, 50 miles to get to the closest emergency department, that means that the next person who calls 911 has to wait until that ambulance is back,” Dr. Muenzer says. “So, it becomes a real issue with resources, and resources are certainly limited when you get into rural America. The advent of an outpatient emergency department means we now can treat these patients closer to home.”
Dr. Muenzer says that above all he wants people to know that OEDs are the same as any emergency department. The only difference is for the small percentage of patients who need to be admitted. Those patients will get transferred to the larger licensed hospital for however long they need to stay.
“You would have no idea that we did not have an inpatient side of things when you walk into the ED,” he says. “We have all the same people, all the same tools, all the same training, and all the same eagerness to fix whatever problem you may have.”