Now you can schedule APPOINTMENTS in the ER...????

Trekfan · Sep 17, 2011

I would not have beleaved it if i did not see it !!

CBsMommy · Sep 17, 2011

Ok. If you have time to schedule an appointment and relax at home, ER is not the place you should be going!

JDZ344 · Sep 17, 2011

Is it actually to see an ER Doc? We have a GP out of hours surgery attached to our ER. It's totally separate but you get to it through ER waiting room.

Altra, BSN, RN · Sep 17, 2011

Why not just say ... we now have a 24-hour walk-in clinic ... and separate it from emergency medicine entirely?

Having worked in an affluent suburban ER, I can see limited use of this concept in "ERs" with a high volume of low acuity patient traffic from a patient population able and willing to use internet access to complete such a transaction. The $4.99 fee will be, IMO, a turn-off -- no one pays $4.99 for call ahead seating at a restaurant. Additionally, this marketing will have to overcome people's emotional attachment to their local hospital to really effectively be able to "distribute" patient flow among several campuses.

Frankly, the urgent care chains (MinuteClinic, MedExpress, etc.) do the low-acuity thing better, in a way that makes most people satisfied with the care, provided that there is an actual physician present.

I also think there is a margin of liability with this ... the laceration with controlled bleeding that does need suturing but because it's not convenient, does not actually present until the window since the time of injury has elapsed. The sprain vs. fracture that turns out to have vascular involvement. The middle aged female who is convinced she "slept wrong" on her left shoulder/left arm. In other words, the presentations that look different to a medical professional who actually eyeballs the patient than they do to a layperson.

Esme12, ASN, BSN, RN · Sep 17, 2011

Why not just say ... we now have a 24-hour walk-in clinic ... and separate it from emergency medicine entirely?
Having worked in an affluent suburban ER, I can see limited use of this concept in "EARs" with a high volume of low acuity patient traffic from a patient population able and willing to use Internet access to complete such a transaction. The $4.99 fee will be, IMO, a turn-off -- no one pays $4.99 for call ahead seating at a restaurant. Additionally, this marketing will have to overcome people's emotional attachment to their local hospital to really effectively be able to "distribute" patient flow among several campuses.
Frankly, the urgent care chains (Minute Clinic, Med-Express, etc.) do the low-acuity thing better, in a way that makes most people satisfied with the care, provided that there is an actual physician present.
I also think there is a margin of liability with this ... the laceration with controlled bleeding that does need suturing but because it's not convenient, does not actually present until the window since the time of injury has elapsed. The sprain vs. fracture that turns out to have vascular involvement. The middle aged female who is convinced she "slept wrong" on her left shoulder/left arm. In other words, the presentations that look different to a medical professional who actually eyeballs the patient than they do to a layperson.

Never thought I'd see the day......:grn:.

I agree about the margin of liability. I wonder how they get around EMTALA and triage. :confused: What are the ramifications are if the "flu" or gallbladder flare up end up being an MI? :eek: Are they actually scheduling their ED wait time or is this for Urgent care? How are they tried on arrival? Not all areas in the country have the urgent care chains (or a "Doc in a box" as I like to call them:smokin:). In my state they have not been allowed by the state and the AMA (who lobby vehemently against them) in the state except in CVS or other pharmacies where there are ANP's.

In my experience in most ED's it's convincing the patients that their injury is NOT life threatening, and they can wait. Especially in the affluent ED I worked in, they all felt entitled to be seen first because of who they were, and what they've donated. I can still see the problem if someone "called in" and arrived having the "big one" and you moved them "ahead" of someone else.......getting the "I paid for my spot first!" crap. Hummmm... :rolleyes:

I'm now actually curious enough to call them to ask just how it's done.... :lol2: .

Altra, BSN, RN · Sep 17, 2011

I wonder how they get around EMTALA and triage.
...
I can still see the problem if someone "called in" and arrived having the "big one" and you moved them "ahead" of someone else.......getting the "I paid for my spot first!" crap. Hummmm...

EMTALA is not the issue ... assuming they're seeing everyone that does present. But you raise a very good point about triage principles. Imagine having to defend your actions as the triage nurse, juggling the VIP call aheads with the walkins who are actually sick. Not a pleasant picture.

kids · Sep 17, 2011

From the link in the OP:

in the ER and MD360 (urgent care) experience.

I've never seen an urgent care that didn't book appts in addition to taking walk-ins, including hospital based urgent care clinics.

littlewingrn · Sep 17, 2011

The comparisons above are to urgent care clinics, not a real Emergency Room. My ED also has an urgent care center attached and once a person is triaged in the ER, it is determined which is the better place for them. I don't see how you can properly triage someone via appt. For that matter, why would you want to turn your ER into an urgent care center? What is the point in calling it an "Emergency Room" at that point? Society as a whole needs to be re-taught the definition of "emergency care" and "emergent" issues. I agree with the poster above, if you are at home in your recliner, it is not an emergency. Unfortunately though, that is not reality, but really now....this is way too much!!!

Trauma Columnist · Sep 17, 2011

Uh lets see, my husband is about to become a full arrest, let me see if I can pre-book and I'll just keep doing CPR at home....

Esme12, ASN, BSN, RN · Sep 17, 2011

EMTALA is not the issue ... assuming they're seeing everyone that does present. But you raise a very good point about triage principles. Imagine having to defend your actions as the triage nurse, juggling the VIP call aheads with the walkins who are actually sick. Not a pleasant picture.

I have something to occupy me for a few days......EMTALA/COBRA/Triage requirements differ between free standing urgent cares and clinics than the ones a part of an Emergency Department. The requirment of the MSE is different for the minute clinics than UC's connected to the main ED's. The medical screening exam and higher level of care requirement if they are presenting to their appointment having an Acute MI, the time to seeing the "triage nurse" or transfer of care to the "higher" level. There are a TON of nuances to the regulations and I'm really curious how they solved the issues. How do you answer that the person with heartburn sat at home while waiting for the MD. What is the real door to MD time, are they seen by triage, where does liability begin?

This has peeked my curosity.....Thanks MWboswell. I have digging to do... :lol2: . I'll get back to this one later.

Pneumothorax, BSN, RN · Sep 18, 2011

i can even......

if you can schedule an appt or hold your spot in the ER triage line...you probably arent that sick in the first place. Judging by the people that i see out in the field, i bet they'd set an appt for their nosebleed then call 911 so they can be transported by ambulance so they "get seen faster"... :rolleyes: