It sounds like a nutritional supplement, the kind with whey protein and effectiveness measured in degrees of creatine. But the Inova HealthPlex—a freestanding emergency department in Franconia-Springfield, Virginia—may have an even more important formula: one for strengthening overburdened ERs.

Profiled in today's Washington Post, the HealthPlex treats some 33,000 patients a year, helping relieve the pressure on ERs in Inova's other hospitals. An average patient visit takes about two and half hours—close to half the average time for the ERs in the state of Virginia.

Its success can be attributed to how it processes patients as well as its unique position in the market.

HealthPlex has all the capabilities of a regular ER but no inpatient beds. Patients requiring surgery or hospitalization are transferred to one of the nearby hospitals. Boarding (time spent waiting for an inpatient bed) in the HealthPlex ER is limited to four hours, according to one of the nurses. Onsite laboratories and imaging facilities allow HealthPlex to effectively practice advance triage, starting diagnostics for certain conditions before the doctor even sees them.

As the article notes, the stand-alone emergency room also enjoys some significant advantages over hospital ER. Nearly 90 percent of its patients are insured (compared to about 85 percent nationally) and only 10 percent require hospital admission (compared to averages of 25 and 30 percent in the ERs of nearby hospitals)

HealthPlex intrigues us as model for improving patient flow and ultimately reducing the burden on our nation's ERs. As the article also notes, programs, like surgical smoothing, which spread out the number of elective surgeries more evenly over the five days of the work week, can also help hospitals improve capacity. We can also imagine a world in which electronic health records enabled records of a patient's late night HealthPlex visit to be easily transferred to his primary care physician.

That is, if they have such a physician.

As we've noted here before, ER crowding is closely related to how long people have to wait for an appointment at a clinic or doctor's office. Treating patients in ERs more efficiently is important, but even more important is efficiently treating patients before the ER. Today's Post also notes that the rate of uninsured Virginians is on the rise, climbing from 13.3 percent in 2006 to 14.8 in 2008. Without coverage, these people are less likely to have a source of routine care and more likely to delay or forego nonemergency care. When they do go for care at the only source available for them, the ER, it is for a more serious and expensive condition. The uncompensated care they generate creates a financial burden on hospitals that is borne by all of society.

Stand alone emergency departments may be a supplement to but not alternative for more comprehensive health reform that strengthens our delivery system while providing affordable coverage to all Americans. For more the effects of our ER crisis and what to do about it, check out this recent issue brief from New America on ambulance diversion. You can also read our related blog posts (here, here, and here).