Emergency Rooms Adopt Online Reservation System

Need a tetanus shot? Take a number. But feel free to wait in the comfort of your own home.

A new online service is aiming to take the "wait" out of emergency room visits -- or at least change where it's done.

Hospitals that partner with InQuickER enable patients -- those with truly non-emergent conditions, at least -- to make reservations for ER visits online, much the way they would book a table at a restaurant through OpenTable.com.

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"Patients are just choosing where they wait," said Dr. Kathleen Clem, 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 ER.

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 but 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 percent 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.

Online ER Reservation Ssytem Shows Success

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 ER at exactly that time.

"That's an important caveat in the system," said Dr. Jesse Pines, director of the Center for Healthcare Quality at George Washington University Medical Center, who studies ER 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, he said, it could reduce variation enough so that all patients, even those who don't call ahead, have shorter wait times.

Song said the company does not yet have data on whether that's the case, 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. But most of the hospital administrators said they were keeping a close watch on these metrics.

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 ER," 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 ER."

ER Reservations: Coming to a Hospital Near You?

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."