By Kristina Fiore, Staff Writer, MedPage Today
Published: November 12, 2010
“I’d like to make a reservation for one at 7 p.m., please.”
That’s the idea behind a new online service that is aiming to take the “wait” out of emergency department (ED) visits — or at least change where it’s done.
Hospitals that partner with InQuickER enable patients — those with truly nonemergent conditions, at least — to make reservations for ED visits online, much the way they would book a table at a restaurant through OpenTable.com.
“Patients are just choosing where they wait,” said Kathleen Clem, MD, chair of emergency medicine at Loma Linda University Medical Center in California, which recently implemented the technology. “They’re waiting at home rather than our waiting room.”
She added that they’re “not getting in line in front of someone else.”
At most hospitals, the service costs $24.99, and patients can usually make an appointment for an hour and a half or two hours down the road –- the same amount of time they might have spent had they just shown up at an ED. Patients are guaranteed that they will be seen within 15 minutes of their appointment time or they will get their money refunded.
Chris Song, marketing director for InQuickER, says the system is “designed for those with non-life-threatening conditions.” That could be a urinary tract infection if it’s a weekend and the primary care physician’s office is closed, or a sprain that is not debilitating and doesn’t need immediate treatment.
Hospitals license the company’s software, and about 15 around the country currently participate, including some centers in Florida, California, Georgia, Alabama, and Tennessee.
Since InQuickER began offering the service in 2006, Song says company data show a 95% success rate with keeping appointments.
St. Anthony Hospital in Oklahoma City has had about 700 customers make reservations since May, and so far they’ve only made “a few” reimbursements of that booking fee, according to Sandra Payne, vice president of marketing for St. Anthony.
Since Loma Linda started offering the service a couple of months ago, they’ve only been unable to keep one appointment, Clem said, and that was because multiple traumas presented at the ED at exactly that time.
“That’s an important caveat in the system,” said Jesse Pines, MD, director of the Center for Healthcare Quality at George Washington University Medical Center, who studies ED overcrowding. “A lot of the time, patients come in needing a lot of assistance at once, and staff get sucked into those cases.”
But in general, Pines said, the service appears to do a decent job of spreading out demand throughout the day “so that you can have better demand-capacity matching.”
Ideally, it could reduce variation enough so that all patients, even those who don’t call ahead, have shorter wait times, said Pines, who is also a spokesperson for the American College of Emergency Physicians.
Song said the company does not yet have data on whether that’s the case, but most of the hospital administrators said they were keeping a close watch on these metrics. Nor are there yet data on whether calling ahead actually reduces the amount of time the patient spends in the examination room getting a workup and a diagnosis.
One thing is certain, Song said -– the system won’t let a patient schedule an appointment for later in the day if he or she needs to be seen immediately. Hospitals constantly monitor the requests coming in, and if an acute condition is sensed, a healthcare worker will follow up.
“If someone writes that they’re having chest pains, they get a call,” Clem said.
She also emphasized that the bookings will never take precedence over a true emergency.
“Some people say [making reservations] disadvantage other people, but no one is buying access to the ED,” Clem said. “We still see everyone in the order we need to see them, depending on how sick they are.”
Pines said public perception will be key to the success of the technology.
“Some people will like it, some people won’t,” Pines said. “It really depends on how the local community uses healthcare services and how they perceive the role of the ED.”
Song says InQuickER plans to continue working with its hospital partners and to expand to more centers.
Researchers aren’t sure how implementing the technology across more institutions will mitigate for the fact that national healthcare resources are already stretched, but Clem said “this is one of the ways to be innovative.”
“This isn’t the whole answer,” she said, “but it’s part of a solution.”