Making Reservations for the ER

Dixielee, BSN, RN · Oct 8, 2011

I am considering moving to Southern California early next year and one of the hospitals I have considered is owned by Tenet and uses this system. I check the site periodically just see what they list as the current wait time and it is generally under 30 minutes. I also shook my head when seeing the online fee to make a reservation.

I'm wondering if there is more to this than meets the eye. I currently work in a very busy non profit hospital and our average evening wait times are 3-4 hours. We have 60+ ED beds and there are easily 30 in the waiting room most evenings after 1900. A huge percentage of our patients are either medicaid or self pay (which usually means no pay in our area). The hospital has taken huge losses in revenue over the past few years while trying to serve an ever growing un-insured population. There have been huge cuts in every department.

That said, I wonder if the people who would be most likely to use the online reservation system would be those who are insured or would pay their bill in any case. Instead of waiting to see their PCP, they just make reservations in the ER which essentially will serve as an urgent care for many. It offers convenience of being open 24/7, immediate results for lab and x-ray, Rx on the spot and many other things not available in a PCP office.

By offering this service, hospitals may be boosting their revenue by appealing to another customer base that traditionally come to the ED. Just my 0.02 worth.

Trekfan · Oct 8, 2011

I just do not see how this would work ? If the er is full ,what time do you get on line ?

What happens if you just walk in?

VICEDRN, BSN, RN · Oct 8, 2011

I think these times are triage times, not bed timers or md visit timers. And you know if the patients knew that...all heck would break out.

If it is an md timer, it's a timer that you get a quick glance and possibly pain relief in Triage. This reduces lwbs and puts the responsibility of staying on the patient without addressing their concerns.

As for the practice itself, it makes me clench my teeth in anger so bad that I am ignoring it's existence until it goes away, which it will. It's already getting such bad press.

annister · Oct 8, 2011

It seems to me that if one has the time/physical capacity/mental capacity to get online or call for a reservation for the EMERGENCY room, one may want to consider the possibility that his/her ailment is not an EMERGENCY...

I see an EMERGENCY as something warranting a fairly immediate evaluation, not a DOCTORS APPT at 6:30 when I get off of work. The ED schedule should be based on who's situation is most EMERGENT at 6:30 and not who's reservation is for 6:30. It's not a doctor's office and we shouldn't encourage it's use as such.

I didn't read the link and I don't work ER so I apologize if im way off base here...

mwboswell · Oct 8, 2011

I just do not see how this would work ? If the er is full ,what time do you get on line ?
What happens if you just walk in?

When you show up for your "appt" time, you are still triaged the same way and there are higher priority patients then you, you have to wait. Some programs offer you a refund of your appt "fee", others may have other built in "remorse" protocols for when they can't deliver.

However, know that the software is designed to consider things like time of day, seasonal variations, holiday patterns, current patient mix, current "hold times" etc etc etc -so there is a margin of "flex" built into the appt scheduling to try and also "shift" some of the non urgent cases to a slower time period; in this case, it may be a beneficial thing.

-Mark Boswell

MSN FNP-BC CEN CFRN CTRN NREMT-P

"Support CEN Certification and your local ENA"

mwboswell · Oct 8, 2011

It seems to me that if one has the time/physical capacity/mental capacity to get online or call for a reservation for the EMERGENCY room, one may want to consider the possibility that his/her ailment is not an EMERGENCY...
I see an EMERGENCY as something warranting a fairly immediate evaluation, not a DOCTORS APPT at 6:30 when I get off of work. The ED schedule should be based on who's situation is most EMERGENT at 6:30 and not who's reservation is for 6:30. It's not a doctor's office and we shouldn't encourage it's use as such.
I didn't read the link and I don't work ER so I apologize if im way off base here...

Yep, these kinds of visits are typically not "Emergencies" - and believe me the patient know's that it's not an "life or death" emergency, but it is "their emergency" (I guess)......

Once the Emergency Staff come to realize that it's an Emergency Department in name only, and that actually today's ED is more of a 24 hour urgent care clinic that "oh-by-the-way-also-treats-some-life-or-death-stuff", then the easier it is for that staff to find job satisfaction. The use of the ED for non-emergent stuff isn't going to go away any time soon. AND the hospital isn't going to make any huge changes to divert non-emergency patients...on the contrary - the hospital/system WILL make moves to try to capture MORE patients (or at least a steady stream of patients) as a revenue stream....

Oh, I know, you say "a lot of these patients don't pay"....well, yes, that's true, but then you just cast a bigger net to get more paying patients also. AND some of those patients that "don't pay" eventually have to get admitted to the hospital for a REAL problem. When they do, even if they are uninsured, typically your hospital social work dept (or similar) will work with the patient to get them some welfare assistance/insurance so they BECOME a payor and they can back-bill medicaid or medicare.

The ED really is the gateway to the hospital for admissions for "non-routine" patients (IE: nonscheduled admits)....it doesn't seem like it but truly the ED has it's place in keeping your hospital doors open and the power bill (and the staff salaries) paid. It's just easier to accept when you look at it that way.

That being said, I know there are different types of hospitals across the US and some hospitals (critical access, rural etc) seldom admit at all as they may not have the capacity, BUT, I betcha' your small hospitals, have agreements with the bigger one's that accept their patients and in essence the smaller hospitals become "feeder streams" to the bigger ones - AND all those transfers (or at least most of them) are for admission to the bigger hospital, and for the most part admission = revenue.

-Mark Boswell

MSN FNP-BC CEN CFRN CTRN NREMT-P

"Support CEN Certification and your local ENA"

bill4745, RN · Oct 8, 2011

If you can make an appointment, I don't think you need the ED.

ckh23, BSN, RN · Oct 8, 2011

Can I also put in my dinner order as well? Yes I need an appointment for my crushing chest pain and I'll also take a NY strip medium rare with some champagne on ice.

Dixielee, BSN, RN · Oct 8, 2011

I would venture to say at least 80% if not more of our patients are not emergent anyway. The first few patients of my day yesterday were sore throats (I woke up with a sore throat today). The next batch of 4 wanted to be tested for hepatitis because they has all been sleeping with the same person who just got a call from the plasma center that he was Hep positive. I could go on forever, but anyone who works in an ER knows there is a very small percentage of actual emergencies who arrive at our door.

Hospice Nurse LPN, BSN, RN · Oct 8, 2011

The after hours walk in clinics are big in my area. Insurance is accepted also medicare/medicaid and private pay. I don't, however, think they accept those without a means to pay.

Editorial Team / Moderator · Oct 8, 2011

I was driving towards Savannah the other day and noticed a family practice/urgent care combo. This seems very smart to me! But yes, I am sure up-front payment is required, which is what will always keep the uninsured/underinsured coming to the ER.