Avoid The Rush! Some ERs Are Taking Appointments

Sep 23, 2014
Originally published on September 27, 2014 12:19 pm

Three times in one week, 34-year-old Michael Granillo returned to the emergency room of the Northridge Hospital Medical Center in Southern California, seeking relief from intense back pain. Each time, Granillo waited a little while and then left the ER without ever being seen by a doctor.

"I was in so much pain, I wanted to be taken care of 'now,' " says Granillo. "I didn't want to sit and wait."

But on a recent Wednesday morning, he woke up feeling even worse. This time, Granillo's wife, Sonya, tried something different. Using a new service offered by the hospital, she was able to make an ER appointment online, using her mobile phone.

When they arrived at the hospital, he was seen almost immediately.

"The minute I told her who he was and why we were here, she opened the door and let him in," says Sonia Granillo. "That was a relief ... because I thought he was going to say, 'Let's go, let's go. I can't wait.' "

Hospitals around the country are competing for newly-insured patients, and one way to increase patient satisfaction, they figure, might be to reduce the frustratingly long wait times in the ER. To that end, Northridge and its parent company Dignity Health started offering online appointments last summer; since then, more than 22,000 patients have reserved spots at emergency rooms in California, Arizona and Nevada.

Recently, Dignity stepped up its marketing — with billboards, print advertisements and online and radio spots. One online ad features a woman sitting in a hospital waiting room, and then cuts to her on a living room couch with a dog, as the words on the screen read, "Wait for the ER from home."

Dr. Stephen Jones, who heads the Northridge ER, explains that the system isn't meant to be used during real emergencies — like chest pain or trouble breathing.

"If they have those signs or symptoms, they should pick up the phone and dial 911," Jones says. When patients with appointments get to the hospital, they still may be bumped in favor of people who are more seriously ill.

But hospital executives say the approach makes business sense for hospitals because it gives medical staff a better sense of who will be coming through the door, and it makes patients more comfortable.

Patients want to get access to health care the same way they get services in other industries, such as retail or travel, says Chris Song, a spokesman for InQuicker, a Nashville-based company that offers the online scheduling in California and 25 other states.

"When is the last time someone bought plane tickets at the gate?" Song says.

Still, some critics say the online check-in system may be convenient, but is not necessarily cost-effective. If the country wants to decrease the costs of health care, patients need to be treated at the right place at the right time, says Dr. Del Morris, president of the California Academy of Family Physicians. Patients who can make appointments should do so at their doctors' offices, he argues.

"Emergency rooms are there to take care of people who have emergencies," Morris says.

People with non-life-threatening conditions should make an appointment to see their doctor instead of going to the ER, he says. "We're in a crisis right now with a shortage of access to primary care. I think this emergency room is probably taking advantage of that need."

Jones, the medical director for the emergency room, says some patients who come in through the appointment service probably should be seen by a primary care doctor, but either don't have one or can't get a timely appointment.

"I think this represents a reasonable alternative for patients who are concerned they may have an emergency condition," he says.

On the day of his appointment at Northridge Hospital Medical Center, Granillo winced and shifted uncomfortably in the ER exam room.

After a CT scan, doctors told the couple that Granillo has a very serious condition – lymphoma, a type of cancer. Jones says Sonya was right to insist her husband come in for care.

"She was really worried about his condition and rightfully so," Jones says.

Sonya Granillo says if she hadn't made an appointment, her husband might still not know about his diagnosis.

"Over five days, I have been trying to get him into the ER, and that was my last resort." She says. "And it worked."

Dignity Health also offers the online reservations at urgent care centers and at doctors' offices.

Page West, chief nursing officer for Dignity Health, says she hopes that the new service will minimize wait times and boost patient satisfaction scores — under the Affordable Care Act, Medicare's reimbursement payments to hospitals are tied to results on patient surveys.

This story is part of a reporting partnership between NPR and Kaiser Health News.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

Transcript

STEVE INSKEEP, HOST:

Next time you face an hours long wait for help in the emergency room, consider this - you could've made an appointment.

AUDIE CORNISH, HOST:

There's a "Seinfeld" riff somewhere in there about how making an appointment at the emergency room doesn't match up well with the purpose of an emergency room. But some hospitals now encourage you to make appointments online and wait at home until it's your turn.

INSKEEP: Anna Gorman, of Kaiser Health News, visited one such hospital in Los Angeles.

ANNA GORMAN, BYLINE: Michael Granillo is in the emergency room at Northridge Hospital Medical Center. His legs are numb and there's a sharp pain in his back that keeps getting worse. This is his fourth visit to the ER in a week. The last three times he left without seeing a doctor.

MICHAEL GRANILLO: I was getting irritated because it was so crowded and I didn't have the patience to sit and wait. I was in so much pain and I wanted to be taking care of now. And then and it wasn't happening so I got ticked off and went home.

GORMAN: This time though, things are different. When the 34-year-old Granillo showed up at the ER, the staff was waiting for him. Granillo's wife Sonya used a new online service to make an appointment.

SONYA GRANILLO: The minute I told her who he was and why we're here, she opened the door - let him in. That was a relief on me because I thought he was going to say let's go, let's go, I can't wait.

GORMAN: Hospitals around the country are competing for newly-insured patients. That means cutting ER wait times to make visits less frustrating. Northridge and its parent company Dignity Health started offering online appointments last summer. Since then, more than 22,000 patients have reserved spots at emergency rooms in California, Arizona and Nevada. Dignity Health hospitals are getting the word out, with billboards, web ads and video spots.

(SOUNDBITE OF DIGNITY HEALTH ADVERTISEMENT)

UNIDENTIFIED ANNOUNCER: You told us emergency room wait times were longer than you expected. So we found an unexpected solution - a way for you to wait at home, with our online ER waiting service.

GORMAN: To make an appointment, you get on your phone or computer and pick a time slot - think open table, but for a hospital instead of a restaurant. Then you explain what's wrong and check a box saying you can wait for care. It's designed for injuries or illnesses that are not life-threatening - say an ankle sprain or a high fever. Northridge ER Chief Dr. Stephen Jones says it's not for emergencies like chest pain or trouble breathing.

STEPHEN JONES: If they have those signs or symptoms, they should pick up the phone and dial 911.

GORMAN: But if a patient can make an appointment, it shouldn't be at an ER, according to Doctor Del Morris. He's the president of the California Academy of Family Physicians.

DEL MORRIS: Emergency rooms are the most expensive places to obtain care. It's expensive for hospitals to run emergency rooms and they charge accordingly.

GORMAN: He says people with non-life-threatening conditions should make an appointment to see their doctor instead of going to the emergency room.

MORRIS: We're in a crisis right now with a shortage of access towards primary care. I think that this emergency room is probably taking advantage of that need.

GORMAN: Northridge ER Dr. Jones says some people feel they don't have a choice. For example, Michael Granillo doesn't have a regular doctor and he doesn't know if there's an urgent care center near him. Jones acknowledges that the ER is often not an ideal option.

JONES: Well, I think this represents a reasonable alternative to patients who are concerned that they may have an emergency condition.

GORMAN: Back in the ER, Granillo grimaces as he tries to get comfortable. His wife sits nervously beside him. Dr. Jones waits with them for the results of a CT scan.

JONES: How are you feeling? Do you need more pain medicine?

M. GRANILLO: It's just my back when I was stretching out. She had me stretching like that, it hurt my stomach.

JONES: Yeah, you have to lay out flat like that, so sometimes the positioning isn't comfortable. So we'll get some more morphine for that pain.

GORMAN: The scan results are worse than expected. Granillo has lymphoma - a type of cancer. Jones says Sonya was right to insist her husband come in for care.

JONES: She was really worried about his condition and rightfully so.

GORMAN: Sonya says if she hadn't made an appointment, her husband still might not know about his diagnosis.

S. GRANILLO: Over five days I've been trying to get him into the ER and that was my last resort. And it worked.

GORMAN: Granillo's doctors plan to begin treatment immediately and his family is optimistic. For NPR News, I'm Anna Gorman in Los Angeles.

INSKEEP: She's with our partner Kaiser Health News, which is a nonprofit news service. Transcript provided by NPR, Copyright NPR.