In the United States, there are variety of hospital system types that may be distinguished based on their ownership/operation type. These systems each have unique structural and managerial aspects that differentiate them. The primary hospital types are generally seen as Government owned, private nonprofit, private for profit, and academic. The quality of care received in these institutions may differ based on the key structural aspects that define the hospital type. For example, academic hospitals are known for having various tiers of providers and as such the thorough providence of care may come at the cost of a longer hospital visit.

The Emergency Department is a key facet of medical care and is marked as a positive contributor to the patient in-flow to a hospital system. The presence of an emergency room in a community may be seen as an indicator of better health outcomes. A 2007 publication by Nicholl et al. discussed distance to hospital and patient outcomes in emergency situations. The study found that patients living closer to a hospital tend to have better medical outcomes. For many, the emergency department serves as their primary source of medical care [1]. Though this is not advised, it further emphasizes the importance of the emergency department.

Patient’s choosing which emergency room they go to may affect their hospital experience. Just as hospital structure differs based on hospital type, the emergency department structure is also prone to difference. The effect of stress on decision making has been a long-studied topic. The literature reports that stress strongly affects decision making and causes an individual to not fully consider all the consequences of making a decision [2]. For patients in need of an emergency department, the stress brought on by sickness/injury may cause them to choose an emergency department without fully considering all aspects. A 2013 publication by Newgard et al. suggested that the decision of choosing an emergency department was heavily influenced by the patient and their families, even when transported by ambulance [3]. It is not known whether a specific hospital type would be better for emergency patient care than another.

There is literature present on how different hospital types correlate to differing patient outcomes. A 2002 publication by Devereaux et al. looking into mortality rates in private hospitals found that private for-profit hospitals possessed increased risk of death based on analysis of comorbidity and outlier adjusted mortality rates. Though mortality rates are not an indicator of quality care, it offers a hint that hospital type may in fact affect the type of care received. When it comes to choosing a hospital for care, academic hospitals are generally looked upon as being superior healthcare facilities. Typically, academic healthcare facilities will offer a wide range super specialized services and as a result patients associate them with better medical service [4]. There may be the concern with efficiency given the multi-tiered healthcare structure in medical facilities. A 2018 Kruse et al. looked into efficiency of hospitals by type in the European Union. The study found that public hospitals were not less efficient than private hospitals [5]. A study done on Medicare patients and the cost and quality of care depending on hospital type found that for-profit hospitals were generally associated with higher cost of care but there was not significant difference in outcome by hospital type [6].

The current emergency department structure has a major drawback in the form of long wait times and patient crowding. As reported by a 2015 publication by George and Evridiki, overcrowding of the emergency room is correlated with adverse patient outcomes as well as poor performances by providers [7]. In fact, the literature seems to indicate that patients view the overcrowding and resultant long wait times as negatives. A 2021 publication by Calder-Sprackman et al. suggested that patients like being able to know emergency department wait times prior to going to the hospital. In fact, patients felt greater quality care when they knew the waiting time [8]. Hospitals have taken note of the importance of wait times and are taking steps to reduce waiting times. One popular strategy being employed is a fast tracked approach to reduce wait times and to quickly address patients as they come in [9]. Strategies such as these are being tested to try and innovate the emergency department and improve patient experience in a medical facility.