Freestanding emergency departments have emerged as a popular growth strategy for major health systems in 2026, with organizations looking to expand their market reach and meet the increased demand in growing communities.
The trend is evident with Nashville, Tenn.-based HCA Healthcare and Altamonte Springs, Fla.-based AdventHealth, which have both grown their freestanding ED footprint in Florida. HCA also acquired six Texas freestanding EDs in early February.
Cincinnati-based Bon Secours Mercy Health currently operates 17 freestanding EDs across Ohio, South Carolina and Virginia, and is constantly assessing the healthcare landscape to identify additional opportunities for more freestanding ED investment.
“Freestanding EDs can be built in about 18 months, including design, permitting and construction, compared to three or four years to build an acute care hospital,” Joseph Cazayoux, chief strategic planning and consulting officer, Bon Secours Mercy Health, told Becker’s. “This shorter timeline allows us to deploy freestanding EDs quickly in locations experiencing rapidly growing populations.”
Mr. Cazayoux said BSMH offers multiple types of freestanding EDs, from more streamlined options to ones that comprise outpatient diagnostics, therapeutics, medical office space and ones designed to feature more inpatient capacity. The system also conducts annual reviews to look at potential freestanding ED sites.
He said collaboration with the community, local leaders and emergency medical services is key to ensure education on conditions that are best treated in a freestanding ED setting versus higher acuity conditions more suited for hospital-based EDs.
“Given that patient acuity is often lower in freestanding EDs, we have expectations that our length of stay is shorter and our patient experience scores are higher than hospital-based EDs,” Mr. Cazayoux said. “We have success criteria that we use in our site-selection process, including competition, population growth and population density, among others. Establishing a baseline allows us to conduct retroactive analyses of our sites and adjust our approach to increase the success probability of future sites.”
Winston-Salem, N.C.-based Novant Health is pursuing a similar approach. The health system currently has two freestanding EDs, but has plans to open additional sites across the Carolinas in Charlotte, Winston-Salem, Carolina Shores, Charleston and Bluffton-Hilton Head.
“In many of the regions we serve, communities are growing faster than traditional hospital infrastructure can be developed,” Bryan Dunn, senior vice president, corporate strategy and development, Novant Health, told Becker’s. “Freestanding EDs allow us to quickly expand access to 24/7 emergency care in high-growth areas, reduce travel time for patients experiencing medical emergencies and relieve pressure on hospital-based emergency departments, while remaining fully integrated with our inpatient facilities.”
Like BSMH, Mr. Dunn said hospital-based EDs and freestanding EDs “play complementary roles” at healthcare organizations. While a traditional hospital ED is essential for high inpatient demand and higher acuity needs for trauma and other specialized services, freestanding EDs offer decompression to hospital-based EDs, expanding access to areas that don’t require a full hospital campus.
Freestanding EDs can also help bridge care gaps while other sites with deeper care resources are developed.
“For example, Novant Health Clemmons Medical Center began as a freestanding emergency department in 2013 and our future Novant Health Scotts Hill Medical Center is currently serving patients as a freestanding emergency department in Wilmington [N.C.],” he said.
Mr. Dunn said while workforce challenges are no stranger to emergency medicine, Novant Health uses a systemwide staffing model and clinical protocols to ensure its freestanding EDs offer the same quality patient care as its hospital-based EDs. The system emphasizes competitive compensation, strong benefits and a supportive environment to recruit and retain employees.
Lastly, as Novant Health continues to evaluate adding more freestanding EDs to its portfolio, the nonprofit system is also keeping a close eye on how it tracks the models’ success.
“Patient volume is only one measure of success,” he said. “We also closely track patient outcomes, patient experience scores, wait times, safety and quality metrics, transfer efficiency and the extent to which freestanding EDs help decompress nearby hospital emergency departments. Access metrics, including reduced travel times and improved EMS response efficiency, are especially important. For us, success means improved access, consistent quality and a meaningful, positive impact on the community.”
