There's no hospital attached to the emergency department at the Heathcote Health Center, but the freestanding ER has most everything it needs.
Ambulance bays and a medical helicopter landing pad are out back. An imaging center provides X-rays and CT scanning, and a MRI is coming soon. There's a laboratory, trauma suites -- and rarely more than a couple of people in the waiting room.
In the nine months since the 11-bed facility opened in this northern Virginia bedroom community, more than 1,000 patients a month have come through the doors with everything from cardiac arrest to a sore throat.
Heathcote is here mostly because the rapid population growth has clogged the roads and the route to the nearest hospital.
"Our fire departments and rescue services tell us the average run time here is seven minutes. Not only does that get patients in quickly, it also gets ambulances back in service faster, which is important when they still rely on mostly volunteers,'' said John Viglo, executive director of the center, part of the non-profit Prince William Health System.
The service inside is faster, too. The average wait time in an ER in Virginia is five hours; at Heathcote, it's eight to 10 minutes.
"There is a convenience factor for walk-in patients,'' Viglo said. "We're seeing very few people with no insurance or who don't have a regular doctor, but we are open 24/7 and they aren't.''
Although many insurers make patients pay larger co-pays or even deny claims for visits that aren't a true emergency, that hasn't stopped the flow of the ordinary.
Of the walk-ins, the mix is about the same as any ER, as suggested by some studies.-- four out of five patients have a problem that could probably be treated elsewhere.
"We don't encourage them to use us for routine stuff, but I've already seen several patients more than once,'' said Dr. Joseph Zurlo, emergency medical director for both Heathcote and its parent, Prince William Hospital. "Those who don't have a local source of care are given referrals to primary care doctors before they're discharged."
The Heathcote ER -- one of about 200 such facilities in the country -- handles a minuscule number of the more than 120 million emergency department visits made each year at nearly 4,600 ERs nationwide. That's nearly 30 million more visits from a decade ago, even though the number of ERs has fallen by more than 250.
A Scripps Howard News Service review found that access to primary care is deteriorating across much of the country, driving millions of people outside traditional family practices, or leaving them without care. Because, under federal law, they must at least evaluate everyone who comes through their doors, emergency departments can be a last resort for care, albeit far from perfect in may respects.
The American College of Emergency Physicians recently gave the nation's ER system a D-minus for access of care and a C-minus overall.
Overcrowded and slow ERs are "definitely a symptom of deeper problems in the health care system,'' said Carol Steinberg, a vice president of the American Hospital Association.
A recent study by researchers at Massachusetts General Hospital found that to have at least one board-certified emergency physician on hand at every ER around the clock would require 40,000 such physicians. There are currently only about 25,000 with such training.
On a recent Saturday shift, Zurlo cared for 23 patients.
"I sewed up kids, I took care of chest pains, I treated diabetics. And when I went home that night I felt really good -- I felt I had done something really worthwhile," Zurlo said. "It's more like a family practice in a small town. And the people we see feel like they've been treated well."

(E-mail Lee Bowman at bowmanl(at)shns.com. Distributed by Scripps Howard News Service, http://www.scrippsnews.com)
With DOCS-COMMUNITY, DOCS-FACTBOX, DOCS-DATABASE